1High-yield associations
| Finding or trigger | Classic association | The exam point |
|---|---|---|
| Psychosis, orofacial dyskinesia and seizures | Anti-NMDA receptor encephalitis | Look for ovarian teratoma; start immunotherapy before antibody results. |
| Painful third nerve palsy with a dilated pupil | Posterior communicating artery aneurysm | Urgent CT angiography; a pupil-sparing palsy in diabetes is usually microvascular. |
| Ptosis and diplopia worse after gentamicin or IV magnesium | Myasthenia gravis | Aminoglycosides, fluoroquinolones and magnesium unmask it; CT chest for thymoma. |
| Proximal weakness that improves with effort, dry mouth, absent reflexes | Lambert-Eaton myasthenic syndrome | VGCC antibodies; search for small cell lung cancer. |
| Optic neuritis, myelitis over three or more segments, hiccups | NMOSD (AQP4-IgG) | Natalizumab fails to control it. PBS lists ravulizumab for NMOSD. |
| Headache and papilloedema with normal brain imaging | Idiopathic intracranial hypertension | Exclude venous sinus thrombosis with venography; vision decides urgency. |
| Dorsal column loss after recreational nitrous oxide | Subacute combined degeneration | Serum B12 can be normal: check methylmalonic acid; give hydroxocobalamin. |
| Confusion, ophthalmoplegia and ataxia in alcohol use | Wernicke encephalopathy | Parenteral thiamine before glucose; don't wait for all three features. |
| Rapidly progressive dementia, myoclonus, cortical ribboning on DWI | Sporadic Creutzfeldt-Jakob disease | CSF RT-QuIC; EEG may show periodic sharp wave complexes. |
| Mixed upper and lower motor neurone signs, no sensory loss | Motor neurone disease | Test for SOD1 variants: PBS lists tofersen for amyotrophic lateral sclerosis. |
| Parkinsonism with early falls and vertical supranuclear gaze palsy | Progressive supranuclear palsy | Poor levodopa response; midbrain atrophy on MRI. |
2Australia-only high-yield (won't be in UK or US banks)
Thrombolysis (Stroke Foundation Living Guidelines, 2025). Disabling ischaemic stroke within 4.5 hours: tenecteplase 0.25 mg/kg (maximum 25 mg), else alteplase 0.9 mg/kg (maximum 90 mg).
Wake-up and late stroke (Stroke Foundation, 2025). With perfusion mismatch, tenecteplase or alteplase up to 9 hours from last known well or from the midpoint of sleep, and tenecteplase may be given from 9 to 24 hours (a weak recommendation), in each case unless a large vessel occlusion has immediate thrombectomy access. Thrombectomy for large vessel occlusion if it can start within 24 hours.
Secondary prevention (Stroke Foundation). Minor stroke or high-risk TIA: aspirin plus clopidogrel within 24 hours, for three weeks only. LDL-C under 1.8 mmol/L. In AF, a DOAC within 48 hours of minor to moderate stroke, from day 6 to 7 after major stroke.
Driving (Stroke Foundation, citing Austroads 2022). Private: four weeks after stroke, two after TIA. Commercial: three months after stroke, four weeks after TIA.
Migraine (PBS, October 2026). Galcanezumab and fremanezumab: treatment-resistant migraine; eptinezumab: chronic migraine (Authority Required). Erenumab, rimegepant and atogepant: not found in the PBS medicine index.
MS, ALS and dementia (PBS and TGA, October 2026). PBS lists natalizumab, ocrelizumab, ofatumumab, ublituximab, alemtuzumab and cladribine for MS (Authority Required), and tofersen for ALS. Lecanemab and donanemab have TGA product information; neither was found in the PBS medicine index. Lacosamide and perampanel: focal onset and idiopathic generalised tonic-clonic seizures (Authority Required); nusinersen and risdiplam: SMA.
Myasthenia and CIDP (NBA Ig Criteria, 2026 and 2023). Maintenance IVIg in MG: MGC score 4 or more, two other treatments failed, no PBS-subsidised C5 or FcRn inhibitor, not pure ocular MG; in both, stop if no benefit by four months.
3Sample questions (Physify format)
1. A 68 year old man went to bed well at 11 pm and woke at 7 am with left hemiparesis and neglect. At 8.30 am, CT shows no haemorrhage, CT angiography shows no large vessel occlusion, and CT perfusion shows a mismatch. Under the 2025 Australian stroke guideline, what is the most appropriate treatment?
- A. No thrombolysis, because the onset time is unknown
- B. Intravenous tenecteplase 0.25 mg/kg now
- C. Alteplase only if MRI shows FLAIR-diffusion mismatch
- D. Aspirin plus clopidogrel for three weeks instead
- E. Endovascular thrombectomy without thrombolysis
Answer: B
B. Correct. With perfusion mismatch, thrombolysis is recommended up to 9 hours from the midpoint of sleep in wake-up stroke (Stroke Foundation 2025); 3 am to 8.30 am is 5.5 hours, and tenecteplase 0.25 mg/kg is the dose.
A. Unknown onset does not exclude him: the midpoint of sleep and imaging mismatch make him eligible.
C. FLAIR-diffusion mismatch is another route for unknown onset, not a requirement when perfusion mismatch is shown.
D. Dual antiplatelet therapy is for minor stroke or high-risk TIA, not a disabling deficit eligible for thrombolysis.
E. There is no large vessel occlusion to retrieve.
2. A 58 year old woman has acetylcholine receptor antibody positive generalised myasthenia gravis with a Myasthenia Gravis Composite score of 9 despite pyridostigmine, prednisolone and azathioprine. She is not on a complement or FcRn inhibitor. Maintenance IVIg is started under the National Blood Authority Criteria. When must its effect be reviewed?
- A. After the first infusion, stopping if there is no response
- B. Within four months, stopping if there is no benefit
- C. At 12 months, with no earlier review required
- D. Only once prednisolone has been weaned to zero
- E. No review is needed while she remains on treatment
Answer: B
B. Correct. NBA Criteria (MG, 2026): give IVIg for four months (induction plus three maintenance cycles), abandon it if there is no benefit, then review by a neurologist annually.
A. One infusion is too early to judge; the criteria set a four-month trial.
C. Annual review applies only after the first four-month review shows benefit.
D. The criteria note that IVIg has shown no steroid-sparing effect in MG maintenance.
E. Continuation needs documented clinical effectiveness at each review.
3. A 52 year old interstate truck driver has a minor ischaemic stroke and recovers fully, with no deficit that would affect driving. Under the Australian standard as the Stroke Foundation guideline sets it out, what is the minimum period before a conditional commercial licence can be considered?
- A. Two weeks
- B. Four weeks
- C. Three months
- D. Six months
- E. Never: commercial driving stops permanently
Answer: C
C. Correct. Commercial licence holders: at least three months after stroke, then a conditional licence with annual review may be considered (Stroke Foundation, citing Austroads 2022).
A. Two weeks is the advisory period after TIA for a private licence.
B. Four weeks is the private licence period after stroke, and the commercial advisory period after TIA.
D. Six months is the New Zealand period after TIA for commercial drivers, not the Australian standard.
E. Permanent stand-down is the general New Zealand position after stroke, not Australia's.