USMLE Step 2: Neurology
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1. What are the four
functions of Cranial
Nerve III?
2. What are the three main
functions of the
trigeminal nerve?
3. What are the functions
of the facial nerve?
4. The glossopharyngeal
nerve supplies taste to
the remaining tongue.
What are its five other
functions?
5. The vagus nerve is
pretty much the busiest
nerve. What are its 6
functions?
6. What is a facial upper
motor neuron lesion,
and how will it therefore
present on the face?
7. How will a lower motor
neuron lesion of the face
present?
8. What is the cause of
Bell's palsy, and how is it
related to upper and
lower motor neuron
damage?
Oculomotor Nerve: 9. How does Bells'
Palsy present?
Eye movement (Sup. Inf. Med.
Rectus + Inf. Oblique)
Pupillary constriction
Lens accommodation
Eyelid opening (Levetor Palpebrae
superioris)
Mastication
Facial sensation
Intracranial sensation
Lacrimation
Facial movement
Front 2/3 taste Ipsilateral facial paralysis with inability
Lacrimation to close affected eye
Salivation 10. Bell's Palsy is seen "ALexander Bell with an STD"
Eyelid closing as a complication
Sensation of oropharynx most often of what AIDS
Swallowing diseases? Lyme's
Parotid gland (salivation) Sarcoidosis
Carotid and sinus Tumors
chemo/baroreceptors Diabetes
Gag reflex 11. What proportion 20%
Epiglottic taste of strokes are
Swallowing haemorrhagic, and Do CT scan immediately to determine if
Palatal elevation as such, what is the ischaemic or haemorrhagic
Talking first-line scan in a
Sensation of thoracoabdominal suspected stroke?
viscera 12. What is the Contralateral limb movement
Aortic arch chemo and function of the
baroreceptors lateral
Damage to the cortex supplying corticospinal
the face tract?
13. Where does the Cervicomedullary junction of pyramids
Causes contralateral paralysis of corticospinal tract
lower face only dessucate?
Ipsilateral paralysis of upper and 14. What information Fine touch, vibration and conscious
lower face does the dorsal proprioception
column carry?
UMN damage is before the facial 15. What information Pain, temperature
nucleus and LMN is after the facial does the
nucleus. Bells' palsy is destruction spinothalamic tract
of the nucleus itself, or its efferent carry?
fibres.
16. How do you 23. What parts of the body are affected Contralateral face
remember what by an MCA occluded stroke? and arm to waist
dorsal root
24. What two symptoms are consistent Contralateral paresis
reflexes are
with ACA occluded stroke? and sensory loss (of
tested?
leg)
Cognitive and
personality changes
Count up in order:
25. What main symptoms are consistent Peripheral Territory
S1,2 (Achilles)
with a PCA occluded stroke? Sx:
L3,4 (Patellar)
-Homonymous
C5,6 (Biceps)
hemianopia
C7,8 (Triceps)
-Dyslexia/alexia
17. The babinski During the first year of life -Memory deficit
reflex, an -Face blindness,
indicator of an visual agnosia (object
Upper Motor blindness)
Neuron lesion, is
normal when? Central Territory Sx:
18. Extracranial Carotid (internal and external) -Pain, dysthesiae,
artherosclerosis Vertebral sensory impairment
of which three Basilar -Involuntary
arteries increases movement - chorea,
the risk of stroke? intention tremor,
hemiballismus
19. What three Hypertension
chronic medical Hypercholesterolaemia 26. Coma and "locked-in" syndrome are Basilar artery
conditions are the Diabetes consistent with a stroke due to
cause of nearly all which vessel?
Lacunar infarcts? 27. Other than coma and "locked in" Cranial nerve palsies
20. Atrial fibrillation is Ventricular hypokinesis (as in CMP) syndrome, what main symptoms "Crossed" weakness
the biggest cause Prosthetic valves might someone with a basilar artery and sensory loss
of thromboemboli Marantic endocarditis (non-infectious stroke experience? (ipsilateral face, but
being sent to the valve vegetations) contralateral body)
brain. What, other -heralding
than vascular hemiparesis + coma
pathologies, are may be only
three other symptoms
causes? Dysphagia/dysarthria
Vertigo/N&V
21. What are the Trauma
Visual symptoms
three most Infectious/inflammatory diseases
common causes of Fibromuscular dysplasia (usually young 28. Posterior circulation stokes tend to The four "deadly Ds"
craniocervical females) have four common symptoms. What
dissection (a are they? Diplopia
cause of Dizziness
VTE/stroke)? Dysphagia
Dysarthria
22. What four Speech impairment if dominant
symptoms would hemisphere (aphasias) 29. Someone with a suspected stroke CBC, with platelets
be consistent with Perceptual deficit if non-dominant requires some immediate Blood glucose
an MCA stoke? hemisphere (neglect, apraxia, investigations. What lab tests must PTT, PT and INR
anosognosia) be ordered? Vitals (esp O2 sats)
Contralateral paresis and sensory loss 30. Someone with a suspected stroke Cardiac enzymes and
Visual Sx - Gaze preference to side of requires some immediate cardiac troponin
lesion, Homonymous hemianopia investigations. What cardiac tests Lipid profile
must be ordered?
31. Head CT is usually ordered to MRI may be 38.
distinguish between haemorrhagic ordered later to
and ischemic stokes. When is MRI assess extent of
more useful? damage. More
sensitive, but not as
fast
32. What three things must be Heart - ECG and 39.
investigated in a suspected stroke, Echocardiogram
although not immediately? Hypercoaguability -
e.g. Factor V Leiden
Vascular studies -
Carotid USS,
transcranial
doppler, etc
33. What five tests will allow you to Carotid USS
assess a patient's vascular health Transcranial
following a suspected stroke? Doppler
MRA
CT Angiogram
Conventional
Angiogram
34. What is the primary treatment for tPA within 3 hours
ischemic stroke? of Sx onset - but
you have to do the
full risk-benefit
analysis first
35. If tPA is contraindicated, which it is a Intraarterial
lot, what would be your primary thrombolysis within
treatment? 6 hours of Sx onset
36. What drug should you start ischemic Aspirin (assoc. with
stoke victims on within 48 hours lowered morbidity 40.
(preferable immediately)? and mortality)
37. Other than thrombolysis and aspirin, ICU (for intubation)
what five additional managements
must you consider in ALL patients ICP or herniation
during acute management of ichemic management
stroke?
Additional CT if
deteriorating
41.
Fever and
hyperglycaemic
management
Infection (UTI, 42.
pneumonia) and
DVT prophylaxis
What are the two temporary
measures can be used to
address raised ICP, without
being concerned about
cerebral perfusion (so
excluding raising the head)?
There is a mnemonic for the
contraindications to tPA. What
is it and what does it stand
for?
When would you provide IV
Labetalol or IV Nicardipine in
the setting of a stroke?
Other than immediately
putting the patient on aspirin,
what other drug is required in
the long term after an
ischaemic stroke?
What is the INR target in an
ischemic stroke patient?
Mannitol
Hyperventilation (CO2
dilates cerebral vessels,
raising ICP)
SAMPLE STAGES
Stroke/head trauma (within
3/12)
Anticoagulation (INR>1.7)
MI (recent)
Prior intracranial
haemorrhage
Low platelet count
Elevated BP (>180/110)
Surgery (within 14/7)
TIA
Age (<18)
GI or urinary bleeding (in
past 21/7)
Elevated BGLs
Seizures (due to stroke)
(also, consider risk of
haemorrhagic
transformation depending
on size of stroke - rule of
thumb was tPA good for
small strokes with significant
impacts)
To either lower their BP for
tPA, or if they have severe
hypertension in a
haemorrhagic stroke.
(Remember, Cushing's reflex
means hypertension, and
even hypoxemia, is
tolerable)
Clopidogrel
Depends on co-morbidities
AF or hypercoaguable
states - 2-3
Prosthetic valve - 3-4 (or
add another antiplatelet
agent)
43. When should Stenosis >60% in symptomatic patients, 51. Immediate non-
carotid or 70% in asymptomatic patients) contrast head CT
endarterectomy is indicate in
be performed? suspected SAH
patients. How
44. What are the Trauma (both to head, or circle of willis
sensitive is this
three main causes specifically)
test?
of a sub- Berry Aneurysms
arachnoid Arterio-venous malformation
haemorrhage?
45. What will the Abrupt, intensely painful headache,
presentation of an often with neck stiffness
aneurysmal
subarachnoid
haemorrhage be? 95%

46. What three other Photophobia

(however, in patients with normal mental
symptoms are N&V
status, this is a lot lower)
commonly seen in Meningeal stretch marks
SAH? 52. What should be Immediate LP
done is a SAH is
47. What nerve palsy
suspected but the (? CT cerebral angiography - new
is associated with
CT is negative? research)
berry aneurysms?
53. What will an LP RBCs
show in a SAH? Xanthochromia (yellowish fluid - RBC
breakdown)
Protein
54. When is LP most Between 6-12 and 24-48 hours
accurate in
suspected SAH?
Cranial Nerve III (oculomotor) - with (xanthochromia takes 6-12 hours to
pupillary involvement form, and resolves within 24-48)
48. What is a sentinel A small, transient bleed, also associated 55. What test needs Four-vessel Angiography
bleed in the with sudden onset severe headache. to be run once the
context of Sub- SAH is confirmed?
arachnoid
56. What are the four Prevent rebleeding
haemorrhage?
components (or Prevent vasospasm
49. Other than the Nausea and vomiting five in the case of Reduce ICP
headache, what Diplopia aneurysmal SAH) Treat hydrocephalus
two symptoms are in treating a SAH? (Surgical clipping of aneurysm in
commonly seen in aneurysmal SAH)
a sentinel bleed?
57. How is rebleeding Maintain systolic BP <150mmHg
50. What proportion 1/3 prevented in
of SAH patients SAH?
have experienced
58. What three things Dihydropyridines
a sentinel bleed
must be IV fluids
days to weeks
administered Pressors (BP control)
before the SAH?
when treating
SAH to prevent
vasospasm?
59. How is raised ICP Raise head of bed
acutely managed? Hyperventilation
Mannitol
60. Hydrocephalus can be treated how? Lumbar drain, or 66. Cingulate
serial LPs herniations do not
really have any
61. What are the five main risk factor Hypertension (#1)
specific
for intracerebral haemorrhage? Tumor
symptoms. What
Amyloid angiopathy
four symptoms
(Alzheimer's)
will a downward
Anticoagulation
transtentorial
Vascular malformation
herniation likely
(AVMs, cavernous
have?
hemangioma, etc)
Altered mental status
62. Intracerebral haemorrhage tends to Sudden-onset, severe
present with focal motor and headache
Bilaterally small, reactive pupils
sensory deficit which often worsen N&V
as the hematoma expands. What Seizures
Cheyne-stokes respirations (cycles of
other symptoms might make you Lethargy/Obtundation
faster and slower respirations)
worried about intracerebral (altered level of
haemorrhage? consciousness)
Flexor and extensor posturing (seen in
63. "Berry Aneurysms MAKE a SAH Conditions increasing image)
more likely" refers to what? the probability of
67. A mass located
berry aneurysm, and
where would be
thus SAH
most likely to
cause a
Marfan's
Transtentorial
Aortic Coarctation
Herniation?
Kidney disease (AD-
PKD)
Ehlers-Danlos
Sickle-cell anaemia
Supra-tentorial
Atherosclerosis
History 68. A mass where Middle fossa
would be most
64. What are two things you must do to Elevate bed and
likely to cause an
the patient once brain bleed is administer seizure
Uncal Herniation?
confirmed by head CT? meds
69. What is the staple Ipsilateral "down and out" pupil, which is
65. Which type of herniation may occur Cingulate
sign of an uncal fixed and dilated.
due to a frontal lobe mass?
herniation, and
what is it's Caused by CN III entrapment
pathogenesis?
70. Posterior fossa
mass lesions
would be most
likely to cause
what herniation?

Cerebellar tonsil into foramen magnum

71. What is the main Respiratory arrest, and rapid death 77. What is the usual Obvious, severe trauma and
complication of Due to medullary compression presentation for immediate loss of consciousness,
tonsillar herniation, extradural hematoma? followed by lucid interval
and what is the
78. How long does the lucid Minutes to hours - reasonably
mechanism?
interval usually last in variable
72. Subdural hematoma is Trauma (in elderly or alcoholics) an extradural
the rupture of hematoma?
bridging veins,
79. What is the most Uncal herniation (CNIII palsy)
leading to
common serious
accumulation of
complication of
blood between dura
epidural hematoma?
and arachnoid
membranes. What is 80. What will an extradural
the most common hematoma appear like
cause? on head CT?

73. What are the three Headache

most common general Mental status change
symptoms seen in Contralateral hemiparesis
subdural hematoma?
(you will also get focal signs)
74. What are the
identifying features of
a subdural hematoma
on head CT?

81. Subdural haematoma
usually only requires
surgical evacuation if
symptomatic, whereas
epidural requires it
Crescent shape
immediately and
Does not cross midline (due to falx
regardless. Why?
cerebri)
Tends to have more mass effect 82. What are the five broad
(midline shift, ventricular causes of an acute
obliteration) headache?
Can cross suture lines (because
underneath the dura)
75. Which type of brain Subdural Hematoma (more than a
bleed creates the Epidural anyway)
most mass effect? 83. How long does a
"subacute" headache
76. What is the most Lateral skull trauma/fracture,
last?
common cause of an leading middle meningeal artery
epidural hematoma? tear 84. Primary headaches can
present
chronically/episodically.
(can be anywhere though) What are the three main
other causes which may
present in this way?
Lens-shaped (biconvex)
hyperdensity
Does not cross suture lines
(because between skull and dura)
Because epidurals are arterial
bleeds, which grow much quicker,
resulting in rapid herniation and
death
Primary
Vascular/ischemic
ICP (e.g. tumor, abscess, ICF, bleed)
Inflammatory (e.g. infection,
inflammatory disease)
Acute ocular disease (closed-angle
glaucoma)
Hours to days
Infectious (e.g. chronic sinusitis)
Medication-related (e.g. caffeine
withdrawal)
Neurological (e.g. trigeminal
neuralgia)
85. Recent-onset headaches may Bleeds, infections, and 99. What symptoms are Pain and meningism (N&V,
require immediate work-up. What tumors. associated with all photophobia)
must be ruled out with recent Do CT or MRI migraine types?
onset headaches? Throbbing pain is > 2 hours
(usually under 24; almost always
86. When do recent-onset headaches When they are not
under 72)
require immediate work-up? clearly migraines or
other primary 100. What two factors will Sleep
headaches help relieve most Darkness
migraines?
87. What history and physical exams Full general Hx
need to be done to assess recent- Full neurological history 101. Describe the Unilateral pain
onset headache? Neurologic physical presentation of the Visual aura (either flashing lights
exam (Cranial nerves) "Classic Migraine" or field loss)
Fundoscopy
102. Describe the May be bilateral, and without
88. Lying down and standing up Raised ICP headaches presentation of the aura
affect what type of headache? common migraine
89. In what head location is a Posterior 103. NSAIDs and paracetamol Triptans (1st) (serotonin receptor
headache least likely to benign? are the first line therapy agonist)
for migraines, best used Metoclopramide (D2 antagonist
90. Which two headache types Raised ICP
abortively. What is the - does more than nausea)
typically worsen at night? Cluster
first and second line
91. Jaw claudication and headache Temporal arteritis therapy given by doctors
has high specificity for what to treat migraines?
condition?
104. If migraines are severe or Anticonvulsants (try gabapentin
92. Nausea, photophobia and neck Meningitis frequent, patients usually or topiramate)
stiffness are associated with what Aneurysmal SAH require prophylaxis. TCAs
three conditions? Migraine (less so neck What are your four Propanalol
stiffness) prophylactic treatment CCBs
93. What are the three biggest risk > 50 yrs options for migraine?
factors of headache having a Immunocompromisation 105. Migraines affect females Males
morbid cause? History of malignancy more than males. What
94. What neurotransmitter changes Serotonin about cluster headaches?
are associated with migraines? 106. How will a cluster
95. What is, in its most basic form, the Trigeminal nucleus headache usually
pathogenesis of a migraine? activation present?

96. At what age has migraine onset 20 yrs

usually occurred?
97. Migraines are commonly Aura (can happen with,
associated with what neurological or without pain)
feature?
98. What are the main triggers for Red wine
migraines?* Chocolate
Coffee
Sleep disruption (too
much or too little, Brief, unilateral, excruciating
jetlag, etc) periorbital pain
Stress
107. What symptoms are Lacrimation (and conjunctivitis)
Menses
associated with cluster Ptosis
OCP
headaches? Rhinorrhoea
Fasting
Bright light 108. How long do cluster 30 minutes to 3 hours
headaches tend to last?
109. How often do cluster
headaches tend to occur?
110. What disorders need to be
ruled out in someone with
Horner's syndrome?
111. The acute treatment of a
cluster headache contains
what four components?
112. The prophylactic therapy of
cluster headaches contains
what two components?
113. What type of pain is a
tension headache
associated with?
114. What are some examples of
the non-specific symptoms
associated with tension
headaches?
115. What test needs to be run
in new-onset headaches in
people over 50, screening
for what disease?
116. How is a tension-type
headache treated?
117. What is the usual
pathogenesis of cavernous
sinus thrombosis?
118. What is the most common
causative organism of
cavernous sinus
thrombosis?
Clusters
Seasonal
Same time daily (often night)
Carotid artery dissection
Cavernous sinus infection
High flow O2
Octreotide
Dihydroergotamine
Sumatriptan
Transitional drugs -
Prednisone
Maintenence drugs -
Verapamil, Valproate, lithium,
topiramate
Tight, band-like (without aura)
Poor concentration
Anxiety
Difficulty sleeping (tension
often happen at end of day)
ESR (for temporal/giant cell
arteritis)
Relaxation, massage, hot
baths
Avoidance of exacerbating
factors
NSAIDs/Paracetamol
(tryptans if severe)
(Remember, tension
headaches are a diagnosis of
exclusion, so be sure before
treatment begins)
Suppurative process of orbit,
nasal sinuses or central face,
leading to septic thrombosis
(veins all drain there).
(can be non-septic thrombosis
- but rare)
S Aureus
119. The most common presenting
symptom of cavernous sinus
thrombosis is headache. What
three other symptoms may be
present?
120. Fever is the most common sign
of cavernous sinus thrombosis
(due to its mostly infectious
aetiology). What other signs
may be present?
121. What two tests MUST you run in
cavernous sinus thrombosis?
122. What is the usual treatment for
cavernous sinus thrombosis?
123. If there is no response to
antibiotics within 24 hours in
cavernous sinus thrombosis,
what is your next step?
124. Why should you measure
prolactin immediately after a
seizure?
125. There are many causes of
seizures with a focal onset.
Name the 5 broad categories
Orbital pain
Periorbital edema (due to
venous obstruction)
Visual disturbance
(especially diplopia)
(if the infection spreads
to the CNS, you also can
have meningism,
confusion, drowsiness,
altered mental status, etc)
Ptosis! (or proptosis)
Red eye
Opthalmoplegia
Blood cultures (reveals
organism in 50% of cases)
MRI (with gadolinium and
MR venography). CT +
angiography may also be
used
3 or 4 weeks of
Penicillinase-resistant
penecillin (nafcillin)
PLUS
3rd/4th gen
cephalosporin
(ceftriaxone, cefepime)
+/- Vancomycin (MRSA),
amphoterecin (fungi) or
metronidazole (dental
and sinus anaerobics)
Surgical drainage
Elevated prolactin in the
post-ictal period is
consistent with epilepsy
Tumor
Developmental
abnormality
Infection
Infarction/haemorrhage
AVM
126. List at least five of the causes Hypoglycaemia 136. An EEG needs to be done after (and CBC
of non-neurologic generalised Hyponatraemia preferably during) a seizure to find the Metabolic Panel
seizures Hyperosmolar state eliptogenic focus. However, a string of (TFTs, RFTs, LFTs,
Hepatic encephalopathy other tests need to be run to rule out BGLs)
Drug overdose systemic causes. What tests must be run CRP
Drug withdrawal for someone who has had a seizure? Calcium
(hypocalcaemia
(Also, uraemia, porphyria, can cause
eclampsia, hyperthermia, seizures)
hypertensive Toxicology
encephalopathy, trauma, screen
cerebral hypoperfusion)
+/- prolactin
127. What is a partial seizure? Seizure that arises from
(epilepsy), VBG
discrete, unilateral
(lactic acidosis)
epileptogenic focus, which
(by iteself) does not cause 137. If a seizure appears to be focal, what MRI (focal
a loss of consciousness test must be run? seizure implies
brain lesion)
128. Tumors, alcoholism and brain Adults (over 18 years)
tumors, as causes of seizures, 138. What is the acute treatment for a seizure IV
all tend to affect only which (Note - can still affect lasting greater than two minutes? benzodiazepines
age group? younger [especially (lorazepam) +/-
trauma], but not common) phenytoin
129. Other than tumors and Stroke
ABCs - secure
alcoholism what are the other Metabolic disorder
airway, O2,
significant causes of seizure in
correct
people over 35?
electrolytes and
130. Drug withdrawal as a cause of Adolescents vitals
seizure tends to affect only
139. What is the first line treatment, with Anticonvulsant
which age group? (AVM also only tends to
three drug examples, for partial seizure monotherapy (if
affect this age group)
prophylaxis? it doesn't work,
131. What two causes of seizure are Febrile (due to high fever) try another
common only in children drug):
(under 10) Infection
132. What are some of the features Progressive jerking of Carbamazepine
of a simple partial seizure? successive body regions Phenytoin
Valproate
Hallucinations
(note, same
Emotional disturbance treatment for
(fear, de ja vu) secondary
generalised)
133. What is the key distinguishing It does not involve a loss
feature of a partial seizure? of consciousness 140. What is the first line treatment for partial Phenobarbital
(partial - no alteration. seizure prophylaxis in children?
complex - alteration, but 141. After using anticonvulsant monotherapy, Anterior
not loss) changing drugs and then using temporal
134. What is associated with simple Focal neurological deficit adjunctive drugs, what might be a last- lobectomy
and complex partial seizures, (e.g. hemiparesis) resort treatment for intractable
usually resolving after 24 temporal seizures?
hours, that can be confused (Confirmed not stroke by 142. When giving anticonvulsant dual Lamotrigine
for an acute stroke? MRI) therapy, one drug in particular tends to (plus something
135. What is the most commonly 75% complex partial be used along with another choice. else)
involved lobe creating originate in temporal lobe Which drug is most often used?
complex partial seizures?
143. What is the primary cause of Idiopathic 152. What is the classic
tonic-clonic (grand-mal) EEG finding for an
seizures? absence seizure?
144. What are the three main Loss of consciousness
symptoms of a tonic-clonic Tonic extension of back
seizure? and extremeties
1-2 minutes of repetitive,
symmetric clonic
movements
145. What three other things may Incontinence
occur during a tonic-clonic Tongue biting
seizure? Cyanosis
146. The post-ictal period is Myalgia
3-per-second spike-and-wave
characterised, in a tonic-clonic Headaches
discharges
seizure, usually by confusion
and stupor. What two other 153. What are the first Ethosuximide
features may be present? and second line Valproate
drugs to treat
147. What will the EEG finding of a 10hz during tonic phase
absence seizures?
tonic-clonic seizure show? slow waves during clonic
phase 154. During status CBC
epilepicus, the Metabolic Panel (LFTs, RFTs, CMP,
148. What is the prophylactic Phenytoin OR valproate
cause needs to be BGLs)
treatment of primary tonic- - 1st line
identified. Hence, CRP
clonic seizures? Lamotrigine as adjunct
what tests must be Toxicology screen
run to identify that
(note, secondary
cause? ABGs
generalized have same
Antiepileptic drug levels (one of the
treatment as partial)
most common causes of SE is non-
149. Absence seizures often only Childhood - most compliance)
occur during which part of life? subside before
155. What is the three Maintain ABCs (and rapid intubation if
adulthood
pronged first line refractive to initial drugs)
150. What is the presentation of an Multiple 5-10 second treatment of Status
absence seizure like? periods of impaired Epilepticus? Thiamine, then glucose + naloxone
consciousness and
amnesia, which may be IV Benzodiazepine (Lorazepam) plus
mistaken for phenytoin
daydreaming.
156. What should you Phenobarbitol, Intubate, ICU and
151. What two signs, also often Lip smacking do if a patient with induce a coma with Midazolam or
present in partial seizures, may Eye fluttering status epilepticus is Propofol if needed.
be present in absence seizures? unresponsive to
initial treatment? Continuous EEG and find the damn
cause
157. What form of Infantile spasms
generalised
epilepsy typically
begins at 6
months?
158. What are four main Phenylketonuria (PKU)
specific causes of Perinatal infections
infantile spasms? Hypoxic-ischemic injury
Tuberous sclerosis
159. What is Lennox- A form of childhood seizure that often
Gastaut syndrome? resists treatment
160. How will Lennox-Gastaut Daily, multiple seizures 171. What is the difference Both the same, except that
normally present? Normally between ages 2 and 6. between Vestibular Labyrinthitis will have auditory
Associated with mental Neuritis and Labyrinthitis or aural symptoms, and VN will
retardation, behaviour disorders in terms of presentation? not
and delayed psychomotor
172. What are the Unilateral tinnitus
development
auditory/aural symptoms Ear fullness
161. What kind of seizure is Nocturnal tonic seizure (multiple associated with Hearing loss
most common in daily) labyrinthitis?
Lennox-Gastaut
173. Labyrinthitis and Labyrinthitis - AICA (facial
syndrome?
Vestibular Neuritis can droop - your AICA's pooped)
162. What is Benign Recurrent peripheral vertigo both be mimicked by Vestibular Neuritis - PICA
Paroxysmal Positional resulting from dislodged otolith certain strokes. Which (Don't PICA horse that can't
Vertigo? in semicircular canals (95% strokes mimic what? eat)
posterior canal)
174. What are the three ocular
163. What is the classic Transient, episodic vertigo (< 1 features of peripheral
presentation of Benign min) with torsional nystagmus, vestibulopathy?
Paroxysmal Positional triggered by changes in head
Vertigo (BPPV)? position (e.g. getting out of bed,
reaching overhead)
164. How common is nausea Not common, due to short-
and vomiting in benign lasting nature of the vertigo
paroxysmal positional
vertigo?
165. How is BPPV diagnosed? Dix-Hallpike manoeuvre

(Turn head from 45 degrees right

or left, to the other side, while Abnormal vestibulo-ocular
moving from sitting to supine) reflex

166. What signs will be Vertigo

Horozontal nystagmus - beats
present in a positive Dix Upbeat nystagmus towards the
away from lesion
Hallpike manoeuvre? affected shoulder
167. What three things would Nystagmus for over 1 minute No vertical eye misalignment
raise concern of a Gait disturbance by alternate cover testing
central lesion when Out-of-proportion nausea and
175. MRI with diffusion Atypical eye/neurologic
performing the Dix- vomiting
weighted imaging is findings
Hallpike manoeuvre?
indicated in what five Cannot stand independently
168. How is BPPV treated in Modified Epley manoeuvre patients exhibiting signs of Head or neck pain
most cases? (treats 80%) vestibulopathy? > 50 years
1 or more stroke risk factors
169. If BPPV is not treated by No treatment - usually subsides
the modified Epley within weeks to months 176. What is the drug of choice 25mg Meclozine
manoeuvre, how should Diazepam can be used in a small for treating peripheral
it best be treated? number of cases vestibulopathy, and when Give quite soon, as it can be
should it be given? diagnostic if they feel better
Meclozine is contraindicated! (central causes have a much
poorer response to it)
170. What are the five main Acute onset severe vertigo
features of presentation Head-motion intolerance 177. What is Meniere's disease? Episodic, severe vertigo with
of Vestibular Neuritis, Gait unsteadiness auditory symptoms (tinnitus,
and Labyrinthitis? Nausea, vomiting aural fullness, hearing loss),
Nystagmus often associated with N&V
178. What typically happens Hearing loss (especially low 190. What test should you run in someone Chest MRI - due to
to patients with Meniere's frequency) to the affected side confirmed with Myasthenia gravis? high association with
disease over several Thymoma (15% of
years? pts)
179. How long do episodes of >20 minutes minimum 191. What are the three most Fatiguable Ptosis or
Meniere's disease recognisable features of Myasthenia double vision
typically last? Gravis?
Proximal muscle
180. How is Meniere's disease Clinically:
weakness (e.g.
diagnosed? ->1 episode lasting > 20 minutes
difficulty climbing
-Documented hearing loss,
stairs, rising from
tinnitus and aural fullness at
chair, brushing hair,
least once
etc)
181. What is the treatment for Not much. Migraine diets, BZEs
Meniere's disease? suggested. Ablative therapies if Dramatic
severe fluctuations in Sx
182. Vestibular migraines 10% (more common in females) (typically worsening
affect what proportion of as day progresses)
migraine sufferers? 192. How is Myasthenia Gravis Give
183. How does a vestibular Recurrent mild dizziness to diagnosed? Anticholinesterase -
migraine present? severe vertigo, often with leads to rapid
meningism, N&V. improvement of
symptoms
Headache may be variably
present, mild or severe. Alternatively, Ice
test - put ice pack
184. How long does the minutes to days
on eye for 5 minutes
dizziness last in
and ptosis should
vestibular migraine?
transiently resolve
185. How does vestibular Hearing loss
193. What two antibodies should you test AChR and anti-
migraine thus differ from Aural fullness
for in suspected Myasthenia Gravis? muscle specific
Meniere's disease? Tinnitus (ringing in ears)
kinase (anti-MuSK)
194. What are the two mainstays of Anticholinesterases
(In Meniere's) treatment for Myasthenia Gravis? for symptoms
(Pyridostigmine)
186. What is Syncope? Loss of consciousness due to
abrupt drop in cerebral
Prednisone (or
perfusion (commonly confused
other
with seizures)
immunosuppressant)
187. If Neuro and MSE are Structural CNS cause
195. Mysathenia gravis is when antibodies Lambert-Eaton
both normal after
are directed against ACh receptors. Myasthenic
syncope, what cause is
What is the disease where they are Syndrome
unlikely?
directed against presynaptic calcium
188. How might syncope and Limb jerking channels?
seizure be distinguished? Length of time (syncope < 30
196. What is the most significant risk Small Cell Lung
seconds)
factor for Lambert-Eaton Syndrome? Cancer (60% of
189. What is Myasthenia Neuromuscular disorder due to cases are related)
Gravis? autoantibodies against ACh
197. Multiple Sclerosis is thought to be T-Cell autoimmunity
receptors
due to what?

(High association with

hyperthyroidism)
198. What patients are Females 205. What will be
typically affected Between 20 and 40 revealed on MRI
by MS? Higher distance from equator during in MS?
childhood
199. Describe the four
MS subtypes?

Multiple, asymmetric, often

Relapsing-remitting (65%)
periventricular white matter lesions
Primary progressive (20%)
(commonly on corpus callosum)
Secondary progressive (post RR type)
Progressive relapsing (15%)
Lesions enhance with Gadolinium
200. Which MS type Relapsing-Remitting
206. Other than MRI, LP
has the best
which is also used
prognosis?
to monitor MS
201. What is special Separated in time and space progression, what
about the other test do you
neurological need to run when
complaints in making the
MS? diagnosis?
202. What is Charcot's Most common presenting triad: 207. What three Raised IgG
triad in the features are you Oligoclonal bands (diagnostic)
context of MS? Scanning speech (words broken into looking for in the Mononuclear pleocytosis (i.e. WBCs)
separate syllables) MS LP?
Optic neuritis
208. What should be Prednisone (or other
Nystagmus
given to MS immunosuppressant, like
203. When do MS During hot showers patients during an cyclophosphamide)
symptoms acute
classically exacerbation? Symptomatic treatment (e.g. for urinary
worsen? retention, incontinence, etc)
204. MS symptoms Optic Neuritis 209. What should be Interferon B
are pretty broad Incontinence given to MS (or Natalizumab - 2nd line due to 1:500
and non-specific. Impotence patients to reduce PML risk)
What are some of Unsteadiness/ataxia/vertigo their risk of
the common Depression relapse?
ones Cognitive impairment
210. What is Guillain- Acute, rapidly progressive, acquired
Barre Syndrome? demyelinating autoimmune disorder of
peripheral nerves
211. How serious is Not too bad; 85% will make full
Guillain-Barre recovery within a year. 5% mortality
Syndrome?
212. What are the Campylobacter jejuni infection
three biggest Viral infection
associations with Influenzae vaccine
Guillain Barre
syndrome?
213. What is the main feature of Guillain Ascending paralysis 222. Although both upper and lower motor Eye movement
Barre syndrome? (usually neuron loss symptoms will be present impairment
symmetrical, over in ALS, what symptoms would make Loss of sphincter
several days) you think the disease is not ALS? tone
214. Although atypical variants of the Trunk, diaphragm
(both of these
ascending paralysis in Guillain barre and cranial nerves
tend to be spared
syndrome are common, what are the
in ALS)
commonly affected areas?
223. What does 'Bulbar' involvement mean? Tongue (CN XII)
215. What are "The 5 As" of Guillain Barre Acute inflammatory
and
syndrome? demyelination
oropharyngeal
Ascending paralysis
muscles (CN IX)
Autonomic
are involved
neuropathy
Arrythmias 224. The most common other differential Bulbar
Albuminocytologic diagnosis in ALS is Compressive involvement (it
dissocation Myelopathy. What symptoms tend to indicated
exclude this diagnosis? pathology is
216. What are the two diagnostic tests for Nerve conduction
above the
Guillain Barre syndrome? studies - reduced
foramen magnum)
velocity
CSF protein level > 225. What two investigations need to be MRI (done to
55mg/dL (with few performed in someone with suspected exclude structural
WBCs) ALS? lesions)
Nerve conduction
217. What is the first line treatment for ICU (for airways)
studies (reveal
Guillain Barre syndrome? Plasmaphoresis and
widespread
IVIG
denervation)
(corticosteroids 226. What is the one drug that can offer Riluzole (Na
contraindicated) improvement in ALS? channel blocker)
(physical rehab will
227. What are the main Upper Motor "Everything is up"
also be required)
Neuron symptoms?
218. What is Amyotrophic Lateral Progressive, Spastic paralysis
Sclerosis? degenerative Hyperreflexia
disease with loss of (including positive
upper and lower Babinski's)
motor neurons Pyramidal pattern
of weakness (Arm
219. What is the prognosis of ALS? Usually dead within
extensors; leg
5 years of Sx.
flexors)
220. Which demographics are most Males 40-80yrs
228. What are the four Lower Motor Neuron "Everything is
commonly affected by ALS?
symptoms? down"
221. How will ALS present? Asymmetric
progressive Flaccid paralysis
weakness (over Hyporeflexia
months). Muscle atrophy
May have Fasciculations
fasciculations and
229. What proportion of all dementia is 60-80%
weight loss
caused by Alzheimer's?
230. To confirm dementia, a certain set DEMENTIAS 237. What are the other three Vascular
of differential diagnoses must be (neuro)Degenerative other main types of Parkinsonian
ruled out. What is the mnemonic diseases dementia? Frontotemporal (Pick's
to remember these diagnoses? Endocrine dementia, characterised by
Metabolic Pick's bodies)
Electrolytes
238. What non-blood test CT/MRI - shows atrophy and
Neoplasm
should you run on ventricular pseudo-
Trauma
someone suspected with hypertrophy + rules out
Infection
Alzheimer's? structural causes
Affective disorders
(like depression) 239. What blood tests must you CBC
Stroke/Structural run in Alzheimers? Thyroid function tests
B12/folate levels
231. What are the two identifying Neurofibrillary tangles
Neurosyphillis serology
features of Alzheimer's on (hyperphosphorylated
histology? intracellular tau 240. What is the main drug Cholinesterase inhibitors
protein) which can be used to slow (donepezil)
Alzheimer's progression?
Neuritic plaques 241. In moderate-to-severe Memantine (NMDA
(extracellular B- Alzheimer's, other than antagonist)
amyloid deposition) Donepezil, what drug can
232. What is the cause of Alzheimer's? Amyloid deposition also be used to slow
progression?
233. What are the three main risk Age
factors for Alzheimer's? Family history 242. Which dementia type has a Vascular (due to association
Down Syndrome relatively quick onset? with stroke and
cerebrovascular disease)
(also, female and
educational status) "If changes are abrupt rather
than gradual, think vascular
234. Alzheimer's usually has a pattern Anterograde Amnesia
dementia"
of symptom presentation. What is Language deficit
the pattern? Acalculia 243. What is a risk factor for Really, anything that is a risk
Depression vascular dementia, but not factor for stroke of
Agitation for Alzheimer's? cerebrovascular disease
Psychosis
Apraxia Hypertension, AF, etc etc
Retrograde amnesia 244. What symptoms are Focal neurologic signs
characteristic of vascular
(So, memory dementia, but, if they
formation, speaking, present at all, will only
calculating, happiness, occur very late in
calmness, motor skills, Alzheimer's?
memories)
245. What is the main Significant behavioural and
235. What is the prognosis for Mild cognitive distinguishing feature of personality change early in
Alzhemier's like? impairment up to 10 Pick's dementia? the disease (due to Pick's
years before diagnosis mainly affecting the fronto-
Usually die within 10 temporal lobe, as seen on
years of diagnosis MRI)
236. What is death in Alzheimer's Aspiration pneumonia 246. At what age does Pick's Although sometimes later,
usually due to? disease normally present? normally 50 - 60 (hence being
distinguished from Alzheimer's
which is more commonly after
75)
247. What is normal pressure Treatable dementia due to
hydrocephalus? impaired CSF outflow
248. What is the Wet, Wobbly and Wacky 258. What drug is given to Reserpine (remember because
classic triad of people with acanthosis is snake-like movements)
symptoms seen (Incontinence, ataxia and dementia) Huntington's to
in Normal minimise their
Pressure chorea?
Hydrocephalus?
259. What is the Dopamine depletion in the substantia
249. What is the "Magnetic" - "feet glued to the floor" pathogenesis of nigra (due to death of neurons in Pars
classic gait seen Parkinson's disease? Compacta)
in normal
260. What histiologic Lewy bodies
pressure
feature is seen in
hydrocephalus?
Parkinson's?
250. What is the
261. What is the Resting tremor (pill-rolling)
common CT/MRI
Parkinson's Tetrad? Rigidity - "Cogwheeling"
feature seen in
Bradykinesia
normal pressure
Postural instability (freezing, falls)
hydrocephalus?
262. What might the gait Festinating - wide with short steps,
of someone with no/minimal arm swing
Parkinson's appear
like?
263. What is the Levodopa/Carbidopa
Ventricular enlargement out of
appropriate therapy
proportion to sulcal atrophy
for Parkinson's?
251. How is normal LP or surgical CSF shunting
264. What is Carbidopa? Peripheral Dopa-decarboxylase
pressure
inhibitor. Reduces side-effects (N&V) as
hydrocephalus
smaller concentration of levodopa
treated?
required
252. What is Prion disease - extremely rare form of
265. Other than COMT Inhibitors (entacapone)
Creutzfield- dementia.
Levodopa, a MAO-B Inhibitors (selegiline)
Jakob disease?
precursor to
dopamine, what two
Just know it exists
drugs can be used
253. What is the CAG triplet repeats (the more there are, adjuvantly for
genetic the earlier the disease onset) create Parkinson's
abnormality seen Huntintin protein symptoms?
in Huntington's
266. Which adjunct Selegiline (MAOB I)
disease?
pharmacotherapeutic
254. On what 4 - Autosomal dominant therapy for
chromosome is Parkinson's is also
the abnormality neuroprotective?
in Huntington's?
267. Selegiline is good in
255. What is the Around 20 years til death from time of Parkinson's because
prognosis for diagnosis it reduces the need
Huntington's? for Levodopa. What
256. What are the Chorea is the advantage of
three staple Altered behaviour Entacapone?
symptoms of Dementia
Huntington's?
Reduces motor fluctuations
257. What areas of the Cerebral hemispheres (atrophy)
brain are Caudate and putamen
affected in
Huntington's?
268. What proportion of brain 30% primary 277. What are the four Astrocytoma
neoplasms are primary, and common primary Glioblastoma multiforme (most
as such, what proportion are 70% metastatic brain tumors in common)
metastatic? adults? Meningioma
Acoustic neuroma (Schwannoma)
269. What proportion of primary 40%
brain tumors are benign? 278. Where does an Brain parenchyma
Astrocytoma
270. Most metastatic brain tumors Lung
originate?
will originate from what five Skin (melanoma)
areas? GIT 279. What is the Low-grade astrocytoma is
Breast prognosis of uncommon: prognosis not good (but
Renal Astrocytoma like? better than glioblastoma multiforme)
280. What are the three Seizure
LBGIT Kidney and Skin
main symptoms of Focal deficit
271. What proportion of patients 30% - the point is that Astrocytoma? Headache
with brain tumors present other symptoms (due to
281. Glioblastoma Astrocytoma
with headaches? local growth, mass effect,
multiforme is really
cerebral edema, CSF flow
just a high grade (hence, presentation is similar -
obstruction) predominate
(Grade IV) what? seizures, headaches and focal deficit)

(note - only 8% have only 282. What will

headaches) distinguish a
glioblastoma
272. What are the two most Seizures
multiforme from
common presenting Progressive, focal motor
other tumors on
symptoms in brain tumors? symptoms
MRI?

(used to be raised ICP, but

neuro-imaging has
changed that)
273. Certain brain tumor locations Gait ataxia
lead to certain patterns of
symptoms. What is the usual Cranial nerve deficit
symptom pattern for a
Ring-enhancing lesion (due to
posterior fossa tumor? Raised ICP (CSF
endothelial proliferation plus necrosis
obstruction - headache,
of the tumor itself)
N&V, diplopia)
283. What is the <1 year from diagnosis
274. What is the two symptom Visual loss
prognosis of
pattern for a Parasellar brain Diplopia
glioblastoma
tumor?
multiforme?
275. What is the three symptom Depends on specific
284. From which Pia mater (usually dura or arachnoid)
pattern for a hemispheric location really but:
meningeal layer is
brain tumor?
it rare for
Visual field abnormality
meningioma to
Neurological symptoms
originate?
(lethargy, syncope, aphasia,
apraxia) 285. What is the Depends on grade, but fairly good
Psychiatric symptoms prognosis of a
(depression, personality meningioma? (80% grade II do not recur after
change) radiation or resection)

276. What four metastatic brain Renal cell carcinoma 286. Around what age Median age 65
cancers tend to present with Thyroid papillary do meningiomas
haemorrhage? carcinoma usually occur? (Rare in children unless genetic
Choriocarcinoma disease such as Neurofibromatosis
Melanoma type 2)
287. Acoustic neuroma has a particular Labyrinthitis: 298. Neurofibromatosis is a 6+ Cafe au Lait spots
presentation with parallels to what Vertigo disease increasing the 2+ Neurofibromas
vestibulopathy? Tinnitus incidence of neural 2+ Lisch nodules (pigmented iris
Hearing loss tumors in people and hamartomas)
What specific symptom might with dermatologic Axillary or inguinal freckling
distinguish them? Aural fullness - manifestations, with Optic glioma
present in no cure. What is the Bone abnormality
labyrinthitis diagnostic criteria for 1st degree relative also with the
NF type 1? disease
288. How does acoustic neuroma Signs of CN V-VII
(schwannoma) differ in presentation or brainstem
(must have 2 or more of the
from labyrinthitis? compression
following)
289. What are the three most common Medulloblastoma
299. The diagnostic criteria Bilateral acoustic neuromas
childhood brain tumors? Ependymoma
for NF type 2 is PLUS
Craniopharyngioma
smaller than type 1. 1st degree relative with either
290. Which common primary childhood Medulloblastoma What is it? unilateral acoustic neuroma, or
brain tumor originates only near/in neurofibromas, meningiomas,
the 4th ventricle, causing CSF flow gliomas or schwannoma
obstruction?
300. What is the
291. Which common primary childhood Medulloblastoma, characteristic
brain tumor has the worst prognosis? due to being highly presentation of
malignant Tuberous Sclerosis?
292. Other than medulloblastoma, which Ependymoma
other common childhood brain tumor
can originate in the 4th ventricle, but
may also originate in the other
ventricles and spine?
293. What is the prognosis of a Good - benign
craniopharyngioma? tumor (also the
most common
suprasellar tumor)
Infantile spasms + hypopigmented
294. What is one possible complication of Hypopituitarism
lesion on trunk
craniopharyngioma?
295. What imaging scans need to be run in MRI with AND (remember - generalised epilepsy
a suspected brain tumor? without gadolinium at 6 mts; resolves with ACTH)
301. What is usually the Left - 95% of right-handers; 60-
(CT can also be
dominant speech 80% of left-handers
done in
hemisphere?
emergencies or in
skull base tumors, 302. Distinguish between Broca's is a problem of language
and to obtain Broca's aphasia and production (including writing)
biopsies) Wernicke's aphasia
Wernicke's is a problem of
296. What drug can be used to reduce Dexamethasone
language comprehension
vasogenic edema and thus ICP?
(including their own, so they don't
297. On what chromosomes is Chromosomes 17 make sense, but can at least make
Neurofibromatosis found and what is and 22 words)
the inheritance pattern? Autosomal
303. What is the difference Repetition is not impaired in TMA,
dominant
between Broca's whereas it is in Broca's.
aphasia and
Transcortical Motor They are often confused
Aphasia?
304. Both Broca's and Wernicke's
aphasia can be caused by
(left) MCA stokes, however
there is a slight difference in
terms of how blocked the
vessel is. What is it?
305. Which Aphasia (Broca's or
Wernicke's) will lead to a
"Word Salad"?
306. Define a coma
307. USMLE states nine common
causes of coma. What are
they?
308. Why is drug history so
important in a patient in a
coma?
Broca's - whole MCA tends
to be blocked
Wernicke's -
Inferior/posterior branches
of the MCA
Wernicke's as word
production is not impaired;
there is just a failure to
connect words to their
meaning, so they say
random words without
realising it.
State of unconsciousness
with suppression of
response to stimuli
(less extreme versions are
obtundation and stupor)
Hypoxic
Traumatic
Herniation
Infective
Stroke
Electrolyte disturbance
(hypoglycaemia is the main
one)
Toxic (opiates, BZEs, EtOH
are the 3 main primary
ones)
Generalized Seizure
Endocrine (severe
hypothyroidism)
Metabolic dysfunction
(Thiamine deficiency)
Sedatives are a super-
common cause
309. What tests must be run to CBC
determine the cause of a coma? CRP
Comprehensive
metabolic panel (TFTs,
BGLs, LFTs, RFTs)
Toxicology panel
Calcium
ABGs
Blood and CSF
cultures
(Seizures + ABG =
Status epilepticus
Status epilepticus +
Blood/CSF cultures =
coma)
310. What should be done before CSF Non-contrast CT - to
cultures in a patient in a coma? evaluate
haemorrhage,
herniation or structural
cause
311. Other than a CT, what scan should MRI - evaluate
be done in a patient in a coma and ischemia, especially in
why? brain stem
(again, do before the
LP)
312. What are the three major causes Central pontine
of "Locked-in Syndrome"? myelinosis
Brainstem stoke
(LIS is where pt is awake and alert, (basillary artery)
but can only move their eyes and Advanced ALS
eyelids)
313. What are the four stages of initial ABCs
treatment of someone in a coma?
DONT forget to
reverse the reversible
(Dextrose, Oxygen,
Naloxone, Thiamine)
Find etiology
Prevent further
damage
314. What three nutritional deficiencies B12
will you be most concerned about Thiamine
in terms of creating neurological Folate
symptoms?
315. What is the Confusion 321. How is folate Giving folate BUT only if corrected early.
classic triad of deficiency (Sort of like how Korsakoff's dementia is
Thiamine (B1) Opthalmoplegia (nystagmus, lat rectus reversed? permanent but Wernicke's encephalopathy
deficiency? palsy, conjugate gaze palsy, vertical is reversible)
gaze palsy)
322. Where is Ciliary body
aqueous humor
Ataxia (due to cerebellar and vestibular
produced?
dysfunction)
323. Where is
(Wernicke's Encephalopathy) aqueous humor
drained?
316. In which patients Alcoholics (also at risk for thiamine)
is B1 deficiency Hyperemesis
common? Starvation
Dialysis

(can also be brought on by high glucose

admin, so make sure to give B1 when
giving glucose) Trabecular meshwork (in the iridocorneal
317. How does Korsakoff's is Wernicke's angle of the anterior chamber)
Korsakoff's encephalopathy (ataxia, confusion, 324. How does Damage to the optic nerve by increased
dementia differ opthalmoplegia) PLUS total amnesia, glaucoma ocular pressure (usually loss of peripheral
from Wernicke's horozontal nystagmus and cause visual vision first)
encephalopathy? confabulations field defects?
318. What is Result of B12 deficiency - gradual 325. What is the Open angle
combined progressive onset most common
systems disease? type of
Symmetric parasthesiae, eventually glaucoma?
paraplegia
Stocking glove neuropathy 326. How does Iris dilates and pushes against the lens,
Leg stiffness closed-angle disrupting flow into the anterior chamber.
Spasticity glaucoma The increased pressure behind the iris
Bladder dysfunction occur? then pushes it forward, closing the
Sore tongue iridocorneal angle, exacerbating the
problem
Also patients get dementia, hence if pt 327. How will Extreme eye pain and blurred vision
presents with dementia, measure B12 closed-angle Headache
glaucoma N&V
(treated with huge dose of B12) present?
319. Which patients Pernicious anaemia (also at risk for 328. What is the Prolonged pupillary dilation
are at risk of thiamine deficiency) main risk factor
Combined Strict vegetarians for closed- (also age, FHx and hyperopia/long-
Systems Post-gastric or ileal resection angle sightedness)
Disease/B12 Ileal disease (so, crohn's) glaucoma?
deficiency? Alcoholics/malnourished
329. What are the Hard, red eye
320. Neurological Irritability and personality changes, three physical Dilated pupil
folate deficiency without the neurologic symptoms of examination The dilated pupil is not responsive to light
presents how? Combined Systems Disease (so, without signs of
the parasthesiae, stiffness, spasticity, closed-angle
incontinence and sore tongue) glaucoma?

Often the alcos/pernicious anaemia.

Permanent if not corrected early
330. How might a Similar to migraine with blurred vision 338. How is open Similar to closed angle:
closed-angle angle glaucoma
glaucoma treated? Topical B Blocker - Timolol
present if it +/- CA inhibitor (Acetazolamide)
resolves before +/- Laser trabeculoplasty
you see it (for
339. What are
example, due to
"Cataracts"?
sunlight
constricting the
pupil)?
331. What is the most Blindness
significant and
common
consequence of
closed-angle
glaucoma?
Lens opacification associated with
332. What are the Eyedrops - timolol, pilocarbine
hypertension, diabetes, age and
three main Systemic medications - IV mannitol, IV
radiation
treatments for or oral acetazolamide
closed angle Laser peripheral iridotomy 340. How will Px - loss of acuity and night vision
glaucoma? cataracts Tx - none except surgery
present, and how
(Note - AVOID ALL DILATORS) will they be
treated?
333. How does open- Usually disease of the trabecular
angle glaucoma meshwork slows its ability to filter 341. Which three Females
occur? aqueous humor, leading to gradual demographic Caucasians
increase in IOP. Usually bilateral, unlike groups are at Smokers
closed-angle increased risk of
age-related
334. What is the African american ethnicity
macular
biggest risk
degeneration?
factor for open-
angle glaucoma? 342. How does age- Painless loss of central vision
related macular
335. When should you >35
degeneration
suspect Frequent lens changes
present?
glaucoma? Mild headaches
Visual disturbances and impaired 343. What is the Distortion of straight lines
adaptation to darkness earliest sign of
age-related
336. What is the main
macular
fundoscopic
degeneration?
feature of
glaucoma? 344. What are the two Atrophic ("Dry") - 80% of cases. Gradual
types of age- Exudative/neovascular ("Wet") - 20%.
related macular Severe and rapid
degeneration,
and which is
more common?
Cupping of the optic disc
337. How do you Visual field testing
assess the Fundoscopy (to look for cupping)
severity of open Tonometry
angle glaucoma?
345. How will you 350. Distinguish
distinguish between the
between atrophic physical signs of
and exudative arterial and
macular venous retinal
degeneration on vessel occlusion?
fundoscopy? Atrophic shows pigmentation

Arterial - cherry-red spot on fovea with

Exudative shows haemorrhage or
retinal swelling (whitish nerve fibre layer)
fluid/edema
346. A combination of Vitamins Venous - Choked, swollen optic disc
what will help with haemorrhages, cotton wool spots
slow the Treatment is Vitamins C, E, B-kerotine and edema of the macula
progression of and Zinc.
atrophic age- (pic shows arterial vs venous BRANCH,
related macular Adjust B kerotine in smokers due to lung not central, vessel occlusion)
degeneration?? cancer
351. What is the main Intravascular thrombolysis within 8 hours
(hint - in high
treatment for (or blindness/ischemia pretty much will
doses, one of
central retinal occur)
these things is
artery occlusion?
associated with
lung cancer, 352. What is the main Laser photocoagulation therapy.
whereas another treatment for a Variable results
is associated with central retinal
allround vein occlusion?
mortality 353. Which part of the
increase) optic tract is
347. What is the only VEGF inhibitors - Ranibizumab damaged in:
real treatment +/- Laser targeted phototherapy
for exudative 1.) Unilateral
age-related blindness?
macular 2.) Bilateral
degeneration? temporal field
loss? 1.) Optic Nerve Damage
348. What are the two Central Artery Occlusion 2.) Optic Chiasm Damage (pituitary
3.) Bilateral
types of retinal Central Vein Occlusion tumor, berry aneurysm)
hemianopia?
vascular 3.) Total optic tract damage (MCA, PCA
4.) Bilateral
occlusion? occlusion)
superior
349. Distinguish Arterial - Sudden, painless, unilateral quadrantanopia? 4.) Meyer's loop damage
between the blindness 5.) Bilateral 5.) Other "Meyer's Loop" damage (forgot
presentations of Venous - Rapid, painless, unilateral inferior the name)
venous and vision loss, of variable severity quadrantanopia? 6.) Total optic radiation damage
arterial vascular 6.) Bilateral
occlusion of the Basically arterial is more severe, and peripheral
retina usually quicker hemianopia
(macular sparing
hemianopia)?