Neurology
Neurology questions cluster around stroke, seizures, headache red flags and neuromuscular emergencies. The exam rewards quick recognition and time-critical decisions.
Core rules
- Acute stroke: note the time of onset, check glucose, and obtain urgent CT to exclude hemorrhage. Intravenous thrombolysis within 4.5 hours if no contraindication; mechanical thrombectomy for large-vessel occlusion in selected patients.
- Blood pressure must be below 185/110 mmHg before thrombolysis.
- Status epilepticus: a benzodiazepine first (lorazepam), then levetiracetam, phenytoin or valproate; always check glucose.
- Headache red flags: thunderclap onset, fever with neck stiffness, new headache over 50, focal signs, papilledema, pregnancy or postpartum.
- Guillain–Barré syndrome: ascending weakness with areflexia; monitor forced vital capacity; treat with IVIG or plasma exchange, not steroids.
- Bacterial meningitis: ceftriaxone plus vancomycin (add ampicillin over 50), dexamethasone before or with the first dose.
Worked example
A 66-year-old develops sudden aphasia and right hemiparesis 45 minutes ago. Glucose 110 mg/dL, blood pressure 175/95 mmHg, CT shows no hemorrhage. Reasoning: acute anterior-circulation ischemic stroke within the window. Thrombolysis is indicated if no exclusion criteria, with blood pressure controlled below 185/110. Arrange stroke-unit admission and consider thrombectomy if a large vessel is occluded.
Traps that cost marks
- Missing hypoglycemia as a stroke mimic.
- Giving thrombolysis without excluding hemorrhage.
- Performing lumbar puncture before imaging in raised intracranial pressure.
- Missing posterior-circulation stroke: vertigo, diplopia, ataxia.