Which one of the following is least likely to produce a lymphocytosis in the cerebrospinal fluid?
Correct Answer B:
Cerebrospinal fluid: raised lymphocytes:
Normal values of cerebrospinal fluid (CSF) are as follows:
The following conditions are associated with raised lymphocytes:
Which of the following features is least likely to be found in a patient with tuberous sclerosis?
Correct Answer D: Axillary freckling is seen in neurofibromatosis.
Tuberous sclerosis:
Tuberous sclerosis (TS) is a genetic condition of autosomal dominant inheritance. Like neurofibromatosis, the majority of features seen in TS are neuro-cutaneous.
Cutaneous features:
Neurological features:
Also:
*These of course are more commonly associated with neurofibromatosis. However a 1998 study of 106 children with TS found café-au-lait spots in 28% of patients.
Neuropathic pain characteristically responds poorly to opioids. However, if standard treatment options have failed which opioid is it most appropriate to consider starting?
Correct Answer A:
Neuropathic pain:
Neuropathic pain may be defined as pain which arises following damage or disruption of the nervous system. It is often difficult to treat and responds poorly to standard analgesia.
Examples include:
NICE issued guidance in 2010 on the management of neuropathic pain:
*Please note that for some specific conditions the guidance may vary. For example carbamazepine is used first line for trigeminal neuralgia, duloxetine for diabetic neuropathy.
A 65-year-old man who is known to have metastatic colorectal cancer presents for review. Since last been seen he reports being generally stiff and on examination is noted to have diffuse hypertonia.
Which antibodies are most likely to be responsible for this presentation?
Correct Answer A: This patient has developed stiff person's syndrome.
Paraneoplastic syndromes affecting nervous system:
Lambert-Eaton myasthenic syndrome:
Anti-Hu:
Anti-Yo:
Anti-GAD antibody:
Anti-Ri:
Which one of the following factors indicates a poor prognosis in patients with multiple sclerosis?
Correct Answer D:
Multiple sclerosis: prognostic features:
Good prognosis features:
Ways of remembering prognostic features:
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