Sleep, vestibular & other flashcards
11 high-yield MRCP Part 1 cards from the Intellect Medicos Neurology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is first-line treatment for Bell's palsy, and within what time frame?
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Oral prednisolone, started within 72 hours of onset.
Why? Steroids improve facial nerve recovery. Eye protection (lubricants, taping at night) prevents exposure keratopathy.
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What is the treatment of benign paroxysmal positional vertigo?
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Epley (canalith repositioning) manoeuvre.
Why? BPPV is caused by displaced otoliths in the posterior semicircular canal. Diagnosis is by Dix-Hallpike, which shows rotatory nystagmus.
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What is first-line drug treatment for restless legs syndrome (after correcting iron deficiency)?
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An alpha-2-delta ligand: pregabalin or gabapentin.
Why? Dopamine agonists also work but are less preferred because of augmentation (symptoms worsening and starting earlier) and impulse control disorders.
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In suspected Wernicke's encephalopathy, what is given and in what order relative to glucose?
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IV thiamine (e.g. Pabrinex), given before glucose.
Why? Glucose without thiamine can make Wernicke's worse. The classic triad is confusion, ophthalmoplegia/nystagmus and ataxia.
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Anti-NMDA receptor encephalitis in a young woman: which tumour must be sought?
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Ovarian teratoma.
Why? Removing the tumour, plus immunotherapy (steroids, IVIG, plasma exchange), improves outcome. It typically starts with psychiatric symptoms, then seizures, dyskinesias and autonomic instability.
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Paraneoplastic cerebellar degeneration with anti-Yo antibodies: which cancers are associated?
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Breast and ovarian cancer.
Why? Anti-Yo (anti-Purkinje cell) antibodies damage Purkinje cells and cause severe subacute ataxia.
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LMN facial palsy with a painful vesicular rash in the ear canal: what is the treatment?
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Oral aciclovir plus prednisolone, with eye care.
Why? This is Ramsay Hunt syndrome (VZV in the geniculate ganglion). It has a worse prognosis than Bell's palsy.
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Which drug is used to reduce attacks of Ménière's disease?
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Betahistine.
Why? Ménière's causes episodes of vertigo with sensorineural hearing loss, tinnitus and aural fullness.
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What is the investigation of choice for suspected vestibular schwannoma?
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MRI of the cerebellopontine angle with gadolinium.
Why? Typical features are unilateral sensorineural hearing loss and tinnitus. An absent corneal reflex (CN V) is an early sign.
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Narcolepsy is linked to loss of which neuropeptide, and with which HLA type?
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Orexin (hypocretin); HLA-DR2.
Why? Treatment: modafinil for daytime sleepiness; sodium oxybate at night, which is also the most effective treatment for cataplexy.
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DVLA group 1: how long must a car driver stop driving after a single TIA or stroke?
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1 month.
Why? The DVLA need not be told unless a deficit remains after 1 month. With more than one TIA, 1 month off driving is needed after each episode.