Paper III — Neurology, vision and heat illness

Rapid Revision Grid — Night Before the Examination Topic One-line textbook anchor Single most examinable 2023–2026 update Epilepsy in the elderly 3rd commonest neurological disorder; stroke causes Choose ASM by tolerability, not efficacy; no 40–53%; treat after first unprovoked seizure prophylaxis after stroke; lacosamide/lamotrigine/levetiracetam Coma Arousal (ARAS) + awareness (cortex); GCS ≤8; Cognitive motor dissociation in ~25% (NEJM preserved pupils = metabolic 2024); FOUR score; cEEG for NCSE Subdural haematoma Acute = mass effect; chronic = inflammation from MMA embolisation — EMBOLISE and STEM blood degradation products; subdural drain lowers positive, MAGIC-MT neutral; dexamethasone recurrence harmful (DEX-CSDH)

Lacunar infarct <15 mm deep infarct; microatheroma or LACI-2 (2023): isosorbide mononitrate reduces lipohyalinosis; no cortical signs, no field defect recurrence and cognitive impairment; cilostazol reduces dependence SACD Posterior columns + lateral corticospinal tracts; NICE NG239 (2024): IM hydroxocobalamin brisk knees, absent ankles, extensor plantars immediately in neurological disease; nitrous oxide SACD Motor neuron disease Mixed UMN + LMN in one region; eyes, sphincters Tofersen approved for SOD1-ALS; AMX0035 and sensation spared; riluzole + NIV prolong withdrawn (2024); Gold Coast criteria survival Peripheral neuropathy 11% over 55; diabetes 44%; NCS/EMG is the initial Test for hATTR in progressive "idiopathic" study in unexplained cases neuropathy; screen for DPN at diagnosis of T2DM Neuritic pain Lesion or disease of the somatosensory nervous Suzetrigine (Nav1.8 inhibitor), FDA-approved system; NNT 3.6 TCA, 7.7 pregabalin January 2025; OPTION-DM supports combination Carotid stenosis NASCET method; image within 24 h; CEA within 7 CREST-2 (NEJM 2025): in asymptomatic ≥70%, days for symptomatic 50–99% stenting helped, CEA did not Bedside swallow 78% dysphagic after stroke; gag reflex unreliable; Screen within 4 hours, before any oral intake; use water → purée → solids; watch for wet gurgly voice GUSS or Yale; oral care not antibiotics Visual impairment 75% unreported; cataract, glaucoma, AMD, diabetic Lancet Commission 2024: vision loss is a retinopathy; cataract surgery lowers hip fracture modifiable dementia risk factor; LiGHT — SLT risk first-line for glaucoma Macular degeneration Macula depends on choriocapillaris; CFH + Pegcetacoplan and avacincaptad approved 2023 LOC387715 give 50-fold risk; metamorphopsia; refer for GA — but no functional benefit and rejected for rehabilitation by EMA Heat stroke >40.6°C + CNS dysfunction + anhidrosis; mortality SCCM 2025: cool to <39°C within 30 minutes; up to 80%; cool to 38.9°C within 1 hour "cool first, transport second"; India NPCCHH/IHIP reporting Heat exhaustion <40°C, sweating preserved, sensorium intact; the Distinct case definition and first aid under India's reversible stage before heat stroke National Action Plan on Heat Related Illnesses Prepared from Pathy's Principles and Practice of Geriatric Medicine (6th edition) and Essentials of Clinical Geriatrics (7th edition) as primary sources, supplemented with peer-reviewed literature and guidelines published between 2023 and 2026. Where the textbook position and current evidence differ, the difference is set out explicitly in the Current Practice Update table for that question.