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Neurology

neurological history and neurological examination | common presenting neurological symptoms: headache | blackouts | coma | dizziness | confusion | poor memory | weakness | involuntary movements | pins and needles | pain | common neurological disorders: stroke and transient ischaemic attack | subarachnoid haemorrhage | epilepsy | non epileptic seizures and other psychogenic illnesses | migraine | dementia | multiple sclerosis| Parkinson's disease | myelopathy | motor neurone disease | radiculopathy | peripheral neuropathy| peripheral nerve lesions | meningitis and encephalitis |myopathies | Bell's palsy| Neurological emergencies; coma| raised intracranial pressure| status epilepticus | infection| visual failure | deafness | spinal cord compresson| neuromuscular respiratory failure inc Guillain-Barre syndrome | neoplastic disease | wernicke-Korsakof encephalopathy | giant cell arteritis | nutritional and metabolic diseases of NS | neuropsychiatric manifestations of disease | Brain death and other ethical issues | investigations | neurosurgery

 

Ability to take a competent neurological history and perform a full neurological examination.

Clinical evaluation of the common presenting neurological symptoms such as

  • headache,

exam questions

2004 paper one question 10 Thunderclap headache and investigation for ?aneurysmal bleeding

2004 paper two question 81headache, blurring of vision and ht- malignant hypertension

references

  • blackouts,
  • coma,
  • dizziness,

Exam Questions

2001 paper one question 25 mechanism of Vertigo which occurs with neck extension

References

  • confusion,

Exam Question

2003 paper two question 97 Differentials for confusion and memory loss

References

  • poor memory,
  • weakness,
  • involuntary movements,

Exam Question

2005 paper two question 18 Movement Disorders and drugs

2005 paper two question 38 Movement Disorders and psychotropic drugs

References

http://www.cmdg.org/Movement_/drug/Acute_Parkinsons/acute_parkinsons.htm

  • pins and needles and
  • pain.

Ability to diagnose common neurological disorders including

  • stroke and transient ischaemic attack,

exam questions

2001 paper one question 39 independent risk factor for stroke

2002 paper one question 27dysphagia and features for risk of aspiration

2003 paper two question 88 Early intervention pharmacology in stroke

2004 paper two question 7 Stroke syndromes

2004 paper two question 65 Altered concious stroke and crescendo TIAs

2005 paper one question 66 Stroke syndromes and associated cerebral artery

2005 paper two question 59 Stroke risk carotid disease and treatment

2005 paper two question 68 Diagnosing stroke syndrome on MRI

references

collection of UK guidelines http://www.strokecenter.org/prof/guidelines.htm

Stroke guidelines from UK college of physicians  http://www.rcplondon.ac.uk/pubs/books/stroke/

Australian guidelines from National Stroke Foundation http://www.strokesafe.com.au/pages/article.aspx?id=1&articleid=ArticleID2006526135335&pageId=159&HandlerId=1

  • subarachnoid haemorrhage,

exam questions

2004 paper one question 10 Thunderclap headache and investigation for ?aneurysmal bleeding

2005 paper two question 48 Management of intracerebral heamorrhage

 

references

Guidelines for management of Spontaneous ICH in adults June 2007 http://stroke.ahajournals.org/cgi/content/full/37/2/577

Arteriovenous Malformations of the Brain
Friedlander RM
NEJM 356: 2704, june 28, 2007 clinical practice

  • epilepsy;

exam questions

2002 paper one question 12 use of Vigabatrin in epilepsy and visual complications

2002 paper two question 12 acquired (metabolic, structural) causes of seizure

2002 paper two question 32 diagnosing epilepsy eitiology via EEG

2002 paper two question 31 phenytoin loading doses and half lives

2002 paper two question 57 phenytoin interactions - eg metronidazole

2003 paper two question 30History and MRI to diagnose mesial temporal sclerosis

2004 paper one question 33 Sudden unexpected death in epilepsy

2004 paper two question 35 epilepsy and treatment during pregnancy

2004 paper two question 100 epilepsy treatment with lamotrigine and interactions

2005 paper one question 47 CVD the most common identifiable cause of epilepsy in the elderly

references

Mechanisms of Disease: Epilepsy
Chang B. S., Lowenstein D. H.
N Engl J Med 2003; 349:1257-1266, Sep 25, 2003. Review Articles

The first seizure and its management in adults and children
Bernd Pohlmann-Eden, Ettore Beghi, Carol Camfield, Peter Camfield
BMJ 2006 332;339-342

Epilepsy in elderly people
Martin J Brodie and Patrick Kwan
BMJ 2005; 331: 1317-1322

Status epilepticus: an evidence based guide
Matthew Walker
BMJ 2005; 331: 673-677

Lesson of the week: Misdiagnosis of epilepsy in patients prescribed anticonvulsant drugs for other reasons
M Oto, A J C Russell, A McGonigal, and R Duncan
BMJ 2003; 326: 326-327

Arteriovenous Malformations of the Brain
Friedlander RM
NEJM 356: 2704, june 28, 2007 clinical practice

  • non epileptic seizures and other psychogenic illnesses;
  • migraine,

exam questions

references

Recent advances in the diagnosis and management of migraine
doi:10.1136/bmj.332.7532.25
BMJ 2006;332;25-29
Peter J Goadsby

  • dementia,

exam questions

2002 paper one question 47 Presentations of Creutzfeldt-Jakob disease

2004 paper two question 39 Genetics of CJD

2004 paper two question 71 treatment of dementia

references

Dementia and Cerebrovascular Disease
DAVID S. KNOPMAN
Mayo Clin Proc. • February 2006;81(2):223-230 • www.mayoclinicproceedings.com

  • multiple sclerosis,

exam questions

2001 paper one question 9 Diagnosis of MS

2004 paper one question 19 neuropathology of MS

2004 paper two question 59 Use of alpha 4 integrins in the treatment of MS

 

references

Natalizumab for Multiple Sclerosis
R. M. Ransohoff
N Engl J Med 356:2622, June 21, 2007 Clinical Therapeutics

  • Parkinson's disease,

exam questions

2002 paper two question 50 Treatment of on off symptoms of Parkinson's Disease

2003 paper one question 63 Use of appropriate Antiemetic in parkinsons disease

references

An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines Olanow CW; Watts RL; Koller WC
Neurology 2001 Jun;56(11 Suppl 5):S1-S88

Diagnosis and Initial Management of Parkinson’s Disease
John G. Nutt, M.D., and G. Frederick Wooten, M.D.
N Engl J Med 2005;353:1021-7.

  • myelopathy,

Exam questions

2003 paper two question 8 Weakness associated with myositis

References

  • motor neurone disease,

exam questions

references

Amyotrophic lateral sclerosis
The LancetVolume 369, Issue 957816 June 2007-22 June 2007Pages 2031-2041
JD Mitchell and GD Borasio

  • radiculopathy,

exam questions

2003 paper two question 76 Neck pain Xrays in RA, Cervical subluxation and clinical presentation

2004 paper one question 58 Spinal cord syndromes

2004 paper two question 42 spinal canal stenosis

2005 paper two question 30 Radiculopathy and lumbar MRI

2005 paper two question 79 Clinical presentation of spinal canal stenosis

references

NEJM Primary care: Low back pain (review article) Vol 344(5), 1 Feb 2001 pp 363 - 370

2002 paper one question 30 Mechanisms of foot drop

2003 paper one question 42 Lesions of C5 and brachial plexus

2003 paper two question 75 Differentials for bilateral foot numbness in HIV including drug induced neuropathy

2004 paper one question 47 Foot drop

2004 paper one question 52 Lung Tumour and stellate ganglion (or cervicothoracic ganglion)

 

References

Human Immunodeficiency Virus–Associated Peripheral Neuropathies
SERGIO FERRARI, SANDRO VENTO, SALVATORE MONACO, TIZIANA CAVALLARO, FRANCESCA CAINELLI, NICOLÒ RIZZUTO, ZELALEM TEMESGEN
Mayo Clin Proc. • February 2006;81(2):213-219 • www.mayoclinicproceedings.com

 

peripheral nerve lesions,

exam questions

2002 paper two question 26 Clinical presentation of Trigeminal neuralgia

2002 paper two question 98mechansims for incomplete right third nerve palsy with pupil sparing in patient with T2DM

2005 paper one question 26 Mechanism of Trigeminal neuralgia

2005 paper one question 36 Determining peripheral lesion VII facial nerve from clinical signs

 

References

Repetitive strain injury
The LancetVolume 369, Issue 957526 May 2007-1 June 2007Pages 1815-1822
Maurits van Tulder, Antti Malmivaara and Bart Koes

meningitis and encephalitis,

myopathies and

Exam Questions

2004 paper two question 95 Critical Illness Myopathy

2005 paper two question 28 lower extremity weakness is a clinical sign of steroid myopathy in patient treated for large cell lung ca

References

Bell's palsy.

Recognition and early treatment with appropriate onward referral of neurological emergencies such as

coma,

raised intracranial pressure,

exam questions

2004 paper two question 81headache, blurring of vision and ht- malignant hypertension

references

status epilepticus,

exam questions

References

Status epilepticus: an evidence based guide
Matthew Walker
BMJ 2005; 331: 673-677

infection,

exam questions

2003 paper one question 60 prophylaxis pregnant partner
repeat2004 paper one question 45

2003 paper two question 95Herpes simplex encephalitis

2004 paper two question 36

2005 paper one question 45 coliform central nervous system (CNS) infections and why not to use gentamicin

references

Practice Guidelines for the Management of Bacterial Meningitis Allan R. Tunkel, Barry J. Hartman, Sheldon L. Kaplan, Bruce A. Kaufman, Karen L. Roos, W. Michael Scheld, and Richard J. Whitley Clinical Infectious Diseases 2004;39:1267-84

 

visual failure,

Exam Questions

2003 paper two question 57 Blurred vision and fundoscopy

References

Deafness

Exam questions

2003 paper two question 90 Differential Diagnosis and investigations for profound deafness

References

spinal cord compression,

Exam Questions

2004 paper two question 50 Differentials for spinal cord compression with MRI

 

References

neuromuscular respiratory failure,

including Guillain-Barre syndrome,

neoplastic disease,

exam questions

2003 paper two question 20 Ovarian Cancer and cerebellar syndrome - paraneoplastic syndrome Question repeated 2002 paper two question 56

2004 paper two question 21 MRI and masses in the brain : Repeat question 2003 paper two question 44

references

Paraneoplastic Syndromes Involving the Nervous system
Darnell RB, Posner JB
NEJM 349: 1543, October 16, 2003 Review Article

Brain Tumors
DeAngelis LM
NEJM 344: 114 Jan 11, 2001 review article

Wernicke-Korsakoff encephalopathy and

giant cell arteritis.

Some knowledge of nutritional and metabolic diseases of the nervous system and the neuropsychiatric manifestations of disease.

Exam questions

2002 paper two question 38HIV and neurological presentation - Ddx delerium; demential; psyc; meningism

References

Some understanding of the assessment of brain death and an appreciation of the ethical issues associated with managing brain death, terminal motor neurone disease and the entry of patients with coma, aphasia or confusion into research studies.

Knowledge of the indications, capabilities and limitations of investigations such as CT and MRI of the brain and spinal cord, duplex ultrasonography, spinal CT angiography, MR angiography, EEG, electromyography and nerve conduction studies, evoked potential studies, myelography and invasive digital subtraction cerebral angiography.

Exam questions

2004 paper two question 21 MRI and masses in the brain

Some knowledge of the indications for neurosurgery.

Arteriovenous Malformations of the Brain
Friedlander RM
NEJM 356: 2704, june 28, 2007 clinical practice