0 [{"id":189313,"quiz_id":"11290","answer_id":null,"answerType_id":"2","created_at":"2017-04-11 14:05:59","updated_at":"2017-04-11 14:32:28","questionName":"Match the primary treatment option with the disease.","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":10,"explanation":"Rilulozole improves survival by around 3 months in MND. Pyridostygmine is an acetylcholinesterase inhibitor (enzyme that breaks down acetylcholine at NMJ). Mono-amine depleting drugs can help chorea.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189240,"quiz_id":"11290","answer_id":null,"answerType_id":"2","created_at":"2017-04-11 08:58:07","updated_at":"2017-04-11 14:32:28","questionName":"Match the correct roles of the direct and indirect pathway in the basal ganglia","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":7,"explanation":"The outcome of movement largely depends on the balance of the direct and indirect pathways. Dopamine stimulates the direct pathway & inactivates the indirect pathway","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189246,"quiz_id":"11290","answer_id":null,"answerType_id":"1","created_at":"2017-04-11 09:19:53","updated_at":"2017-04-11 14:32:28","questionName":"Fill in the blanks on Brown-Sequard syndrome","questionTimeSeconds":"0","questionTimeMinutes":"4","questionImagePath":null,"position":11,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189238,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 08:49:51","updated_at":"2017-04-11 14:32:28","questionName":"15y\/ female- Mother reports jerking fit- Hx- Started with epigastric rising sense, when came around evidence of tongue biting & post-ictal confusion 1 hour. Is this a seizure or a blackout?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":8,"explanation":"These were all diagnostic pointers for seizures rather than blackouts","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189236,"quiz_id":"11290","answer_id":null,"answerType_id":"2","created_at":"2017-04-11 08:44:08","updated_at":"2017-04-11 14:32:28","questionName":"Match the type of generalised seizure to its description","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":9,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189237,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 08:47:02","updated_at":"2017-04-11 14:32:28","questionName":"Which anti-epileptic medication is recommended first line for focal seizures?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":1,"explanation":"Valproate & Lamotrigine first line for generalised seizures. Carbamazepine- Inhibits sodium ion channels & sustained repetitive neuron firing. Caution in cardiac disease & bone marrow suppression, S\/E are dry mouth, nausea & ataxia. START LOW & GO SLOW","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189235,"quiz_id":"11290","answer_id":null,"answerType_id":"1","created_at":"2017-04-11 08:41:44","updated_at":"2017-04-11 14:32:28","questionName":"Fill in the blanks on seizures","questionTimeSeconds":"0","questionTimeMinutes":"4","questionImagePath":null,"position":0,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189247,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 09:23:48","updated_at":"2017-04-11 14:32:28","questionName":"In Parkinsonism, the direct pathway is affected by loss of dopamine. What triad of symptoms\/signs is classically seen?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":3,"explanation":"Some of the incorrect answers are seen in Parkinsonism, but are not part of the classical triad.","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189248,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 09:30:29","updated_at":"2017-04-11 14:32:28","questionName":"Select the correct causes of parkinsonism.","questionTimeSeconds":"0","questionTimeMinutes":"3","questionImagePath":null,"position":14,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189251,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 09:34:46","updated_at":"2017-04-11 14:32:28","questionName":"The first drug offered to Idiopathic Parkinson's disease patients should be 1 of which 3?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":5,"explanation":"No drugs should be stopped suddenly (risk of neuroleptic malignant syndrome)","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189249,"quiz_id":"11290","answer_id":null,"answerType_id":"2","created_at":"2017-04-11 09:32:42","updated_at":"2017-04-11 14:32:28","questionName":"Match the Parkinson-plus syndrome with its typical features","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":4,"explanation":"80% of all Parkinsonism is caused by Idiopathic Parkinson's disease","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189314,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 14:07:51","updated_at":"2017-04-11 14:32:28","questionName":"How are acute relapses of multiple sclerosis managed?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":13,"explanation":"Long-term, other symptoms that require management are pain, incontinence, emotional liability, memory loss, fatigue, spasticity and oscillopsia (visual problem where things appear to oscillate)","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189309,"quiz_id":"11290","answer_id":null,"answerType_id":"1","created_at":"2017-04-11 13:52:24","updated_at":"2017-04-11 14:32:28","questionName":"Fill in the blanks on multiple sclerosis.","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":6,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189239,"quiz_id":"11290","answer_id":null,"answerType_id":"3","created_at":"2017-04-11 08:55:03","updated_at":"2017-04-11 14:32:28","questionName":"Order the steps for correct management of status epilepticus","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":2,"explanation":"","question_score_id":null,"lang":null,"questionAudioPath":null},{"id":189245,"quiz_id":"11290","answer_id":null,"answerType_id":"0","created_at":"2017-04-11 09:15:06","updated_at":"2017-04-11 14:32:28","questionName":"What types of sensation travel up the spinothalamic tract?","questionTimeSeconds":"0","questionTimeMinutes":"2","questionImagePath":null,"position":12,"explanation":"Whilst corticospinal & dorsal column fibres cross at the level of medulla, spinothalamic fibres cross at the spinal level","question_score_id":null,"lang":null,"questionAudioPath":null}]

block

Match the primary treatment option with the disease.

Match the text (click and drag)   

(0/0)

Check Order Of Answers

Explanation

Rilulozole improves survival by around 3 months in MND. Pyridostygmine is an acetylcholinesterase inhibitor (enzyme that breaks down acetylcholine at NMJ). Mono-amine depleting drugs can help chorea.

---

Match the text
Multiple sclerosis
Myasthenia gravis
Motor neuron disease
Huntington's disease
Parkinson's disease

Click and drag
Rilulozole
Levodopa
Pyridostygmine
Mono-amine depleting drugs
Beta interferons

Check Order of Answers

none

Match the correct roles of the direct and indirect pathway in the basal ganglia

Match the text (click and drag)   

(0/0)

Check Order Of Answers

Explanation

The outcome of movement largely depends on the balance of the direct and indirect pathways. Dopamine stimulates the direct pathway & inactivates the indirect pathway

---

Match the text
Direct pathway outcome
Indirect pathway outcome
Direct pathway mechanism
Indirect pathway mechanism

Click and drag
Subthalamic nucleus is no longer inhibited. This means it can send signals to the internal globus pallidus and inhibit the thalamus
Inhibition of the internal globus pallidus means the thalamus is no longer inhibited
Movement is initiated
Movement is inhibited

Check Order of Answers

none

Fill in the blanks on Brown-Sequard syndrome

Fill in the blanks  

(0/0)

Check All Answers

---

Brown-Sequard syndrome is a rare phenomenom that can occur with a

Check Answer

of the spinal cord.

Corticospinal and dorsal column nerve pathways cross at the level of the

Check Answer

Meanwhile spinothalamic fibres cross at their

Check Answer

level. If the lesion is on the left spinal cord, there will be (ipsilateral/contralateral)

Check Answer

motor loss. Fine touch and proprioception loss will be (ipsilateral/contralateral)

Check Answer

Temperature and pain loss will be (ipsilateral/contralateral)

Check Answer

This rare syndrome demonstrates the anatomical quirks.

---

Check All Answers

none

15y/ female- Mother reports jerking fit- Hx- Started with epigastric rising sense, when came around evidence of tongue biting & post-ictal confusion 1 hour. Is this a seizure or a blackout?

Select the correct answer(s).  

(0/0)

Explanation

These were all diagnostic pointers for seizures rather than blackouts

---

Seizure

Blackout

none

Match the type of generalised seizure to its description

Match the text (click and drag)   

(0/0)

Check Order Of Answers

---

Match the text
Absence
Tonic-clonic
Tonic
Clonic
Atonic
Myoclonic

Click and drag
Simple generalised seizure, brief muscle jerks usually affecting upper limb, precipitated by alcohol withdrawal & sleep deprivation
Attack may be precipitated by dizziness then convulsions may begin with vocalization- complex seizure- tongue biting, incontinence or urine and salivation are common- patients remain unconscious for around 30 minutes after jerking stops, then post-ictal confusion and often neck and back pain/stiffness
Muscle spasms occurring for a few seconds, usually when patient is sleeping
Sharp repetitive jerks
Sudden loss of muscle tone, usually lasts only seconds and is simple- may result in sudden falls or affect jaw, neck or head
Patients stop what they are doing and ‘space out’ before returning after seconds, without awareness of episode

Check Order of Answers

none

Which anti-epileptic medication is recommended first line for focal seizures?

Select the correct answer(s).  

(0/0)

Explanation

Valproate & Lamotrigine first line for generalised seizures. Carbamazepine- Inhibits sodium ion channels & sustained repetitive neuron firing. Caution in cardiac disease & bone marrow suppression, S/E are dry mouth, nausea & ataxia. START LOW & GO SLOW

---

Phenytoin sodium

Topiramate

Carbamazepine

Diazepam

Lamotrigine

Sodium valproate

none

Fill in the blanks on seizures

Fill in the blanks  

(0/0)

Check All Answers

---

An epileptic seizure is a

Check Answer

of disturbed brain activity, characterised by excessive electrical discharges in groups of brain cells.

It is most common in children and the

Check Answer

Seizures can be classified as focal or

Check Answer

In simple seizures the patient

Check Answer

awareness, whilst in

Check Answer

seizures awareness is lost.

Recurrent generalised seizures in children is called

Check Answer

In children, the most common epileptic syndrome is

Check Answer

This is characterised by a triad of infrequent myoclonic seizures, usually in the (morning/evening/night)

Check Answer

daytime absences and

Check Answer

seizures, often the presenting complaint. These patients require (lifelong/short-term)

Check Answer

treatment and prognosis is good with sodium valproate.

Other epileptic syndromes are

Check Answer

which is common in young girls aged 5-8 and often remises, and

Check Answer

epilepsy, which causes focal seizures & automatisms and is the most common in elderly patients.

To diagnose epilepsy, at least (number)

Check Answer

unprovoked seizures without a better cause are required.

---

Check All Answers

none

In Parkinsonism, the direct pathway is affected by loss of dopamine. What triad of symptoms/signs is classically seen?

Select the correct answer(s).  

(0/0)

Explanation

Some of the incorrect answers are seen in Parkinsonism, but are not part of the classical triad.

---

Bitemporal hemianopia

Action tremor

Masked faces

Depression

Resting tremor

Dementia

Bradykinesia

Anosmia

Intention tremor

Symmetrical tremor

Increased tone

none

Select the correct causes of parkinsonism.

Select the correct answer(s).  

(0/0)

---

Brain injury e.g. anoxia, trauma

HIV infection

Antidopaminergic drugs

Progressive subthalamic patency

Alzheimer's dementia

EBV infection

Huntington's chorea

Wallace's disease

Space occupying lesion

Lewy body dementia

Cerebral AV malformation

Cholinergic drugs

Idiopathic Parkinson's disease

Wilson's disease

Cerebrovascular disease

Progressive supranuclear palsy

Multiple system atrophy

Corticobasal degeneration

none

The first drug offered to Idiopathic Parkinson's disease patients should be 1 of which 3?

Select the correct answer(s).  

(0/0)

Explanation

No drugs should be stopped suddenly (risk of neuroleptic malignant syndrome)

---

MAO-B inhibitor

Levodopa

Dopamine agonist

Anticholinergic

Amantidine

COMT inhibitor

none

Match the Parkinson-plus syndrome with its typical features

Match the text (click and drag)   

(0/0)

Check Order Of Answers

Explanation

80% of all Parkinsonism is caused by Idiopathic Parkinson's disease

---

Match the text
Lewy body dementia
Progressive supranuclear palsy
Corticobasal degeneration
Multiple system atrophy

Click and drag
Alien limb & astereognosis
Early autonomic features, poor L-DOPA response
Early dementia & visual hallucinations
Early falls, especially backwards & vertical gaze palsy

Check Order of Answers

none

How are acute relapses of multiple sclerosis managed?

Select the correct answer(s).  

(0/0)

Explanation

Long-term, other symptoms that require management are pain, incontinence, emotional liability, memory loss, fatigue, spasticity and oscillopsia (visual problem where things appear to oscillate)

---

Oral ciclosporin

Oral beta interferon therapy

IV methotrexate

IV or oral steroids

none

Fill in the blanks on multiple sclerosis.

Fill in the blanks  

(0/0)

Check All Answers

---

MS is an autoimmune disease of the

Check Answer

nervous system, destroying myelin is a lesion called a

Check Answer

These lesions are most common in the

Check Answer

region of the cerebral hemispheres, cerebellum, brainstem, spinal cord and the

Check Answer

nerve. Most patients present with

Check Answer

disease that later becomes

Check Answer

However a small group of patients present initially with

Check Answer

disease. Diagnosis requires at least

Check Answer

episodes of inflammation separated in

Check Answer

and location, without a better explanation.

---

Check All Answers

none

Order the steps for correct management of status epilepticus

Match the text (click and drag)   

(0/0)

Check Order Of Answers

---

Match the Text
1
2
3
4
5

Click and drag
Phenytoin 20mg/kg IV over 20 minutes
Lorazepam 0.1mg/kg if IV access, rectal diazepam 0.5mg/kg if no IV access
5 minutes after seizure starts-
Call for senior help
Rapid sequence intubation (RSI) with thiopentone- done by anaesthetist

Check Order of Answers

none

What types of sensation travel up the spinothalamic tract?

Select the correct answer(s).  

(0/0)

Explanation

Whilst corticospinal & dorsal column fibres cross at the level of medulla, spinothalamic fibres cross at the spinal level

---

Vibration

Temperature

Fine touch

Proprioception

Pain