A 32-year-old woman presents to A&E with headache and vomiting. She was decorating her ceiling this morning when the headache began, felt mainly at the occiput with neck pain. Some two hours later she felt nauseous and vomited and was unable to walk, she also noticed that her voice had altered. She takes no regular medication and has no significant past history. On examination, her acuity, fields and fundi are normal. She has upbeat nystagmus in all directions of gaze, with normal facial muscles and tongue movements. Her uvula is deviated to the right and her speech is slurred. Limb examination reveals left arm past-pointing and dysdiadochokinesis with reduced pinprick sensation in her right arm and leg. Although power is normal, she cannot walk, as she feels too unsteady.
Where is the most likely site of her lesion?
1- Right medial medulla
2- Left medial pons
3- Left cerebellar hemisphere
4- Right lateral medulla
5- Left lateral medulla
Answer: 5- Left lateral medulla
A 16-year-old man presents with difficulty in walking and foot drop. There is weakness of dorsiflexion and eversion of the right foot, with a small area of sensory loss over the dorsum of that foot.
What is the most likely diagnosis?
1- Posterior tibial nerve lesion
2- Sciatic nerve lesion
3- L5 root lesion
4- Common peroneal nerve lesion
5- Deep peroneal nerve lesion
Answer: 4- Common peroneal nerve lesion
Unconscious state, most appropriate treatment is:
- V Thiamine
- V Glucose
- V Flumazenil
- V Naloxone
- I.V Glucagon
Answer: 4-V Naloxone
A 31-year-old man has been referred following a ‘blackout’. This had occurred the previous morning. He recalls waking from sleep, standing up, feeling light-headed and nauseated, lying back on the bed and losing consciousness. He had recovered on the floor. He had not bitten his tongue but his head was badly bruised. His wife had been awoken by him falling to the ground and describes him as being pale and sweaty before giving a loud moan followed by ‘spasms’ of his arms and legs lasting about 20 seconds. He was rousable after a minute.
What is the most likely diagnosis?
1- Cardiac arrhythmia
2- Epileptic seizure
5- Vasovagal syncope
Answer: 5- Vasovagal syncope
Inclusion body myositis is characterized by the following EXCEPT:
- Affected elderly
- Male predominance
- Asymmetrical weakness
- Had long duration
- Helitropes rash
Answer: 5-Helitropes rash
A 62-year-old retired postman awoke with ‘darkened’, impaired vision in the upper half of the visual field of his left eye 3 days prior to evaluation. He described the onset of symptoms as ‘like a shade being pulled down’ over the visual picture. He did not complain of eye pain. He had noted headache for 6 weeks beforehand, and had consulted his GP on three occasions about this. He was told that he was suffering from tension headache, and was prescribed simple analgesics. When questioned specifically he reports having pain at each side of his jaw when he eats, especially towards the end of the meal. He is hypertensive and on treatment with a β-blocker. He has never smoked.
Which of the following diagnoses is likely?
1- Central retinal artery occlusion
2- Non-arteritic ischaemic optic neuropathy
4- Arteritic ischaemic optic neuropathy
5- Optic neuritis
Answer: 4- Arteritic ischaemic optic neuropathy
Corticosteroid are used for treatment of increased intracranial pressure in:
- Brain tumor
- Traumatic brain injury
- Ischemic stroke
- Acute obstructive hydrocephalus
Answer: 1-Brain tumor
An 80-year-old woman with hypercholesterolaemia, ischaemic heart disease and hypertension complains of tingling and numbness in both feet that has been worsening over 6 months. Examination shows her to have altered pinprick sensation over both feet and absent ankle reflexes. Urea and electrolytes are normal, blood glucose is normal and there is no history of alcohol ingestion. She is, however, taking a number of medications for the secondary prevention of vascular problems.
Which of the medications listed below is most likely to have caused her symptoms?
Answer: 4- Simvastatin
A 45-year old man complains of numbness of his left thigh. He feels his balance may be poorer than usual but is not sure of this. He has put on 6.25 kg (1 stone) in weight over the past 6 months. He has mild, chronic, low back pain. There is a family history of a neurological condition, in that his father’s brother is said to have multiple sclerosis. On examination he is overweight. He has some reduction of pinprick sensation over the anterior part of his thigh on the left, with no motor signs. Tendon reflexes are normal. There are no cerebellar signs.
What is the most likely diagnosis?
1- Sporadic multiple sclerosis (MS)
2- Familial multiple sclerosis
3- Lumbar canal stenosis with nerve root entrapment
4- Meralgia paraesthetica
5- Inflammatory disease of the lumbosacral plexus
Answer: 4- Meralgia paraesthetica
A patient is admitted after a head injury. He is drowsy but has no focal signs. He opens his eyes to command, has confused speech and localises a painful stimulus. A CT scan shows a haematoma in the right frontal lobe. You are contacting the on-call neurosurgical team.
How would you grade his level of responsiveness according to the Glasgow Coma Scale?
1- E-3, V-5, M-6
2- E-4, V-4, M-6
3- E-3, V-3, M-5
4- E-3, V-4, M-4
5- E-3, V-4, M-5
Answer: 5- E-3, V-4, M-5
Which of following describe simple partial seizure :
- Associated cerebral involvement
- Loss of consciousness
- Preserved consciousness
- Non of above
- All of above
Answer: 3-Preserved consciousness
A 74-year-old woman has a history of idiopathic Parkinson’s disease, first diagnosed 2 years ago. Although she was initially symptomatically well controlled on a low dose of a levodopa preparation, she is now complaining of increasing rigidity and tremor. She currently takes a preparation of levodopa combined with the peripheral dopa-decarboxylase inhibitor carbidopa (Sinemet), 1 tablet three times per day. She feels that the effect of the medication wears off after a couple of hours, and now has frequent fairly prolonged ‘off’ periods.
What would be the most appropriate initial change to her medication regime?
1- Apomorphine injections as required for ‘off’ periods
2- Addition of amantidine
3- Addition of entacapone (a catechol-O-methyltransferase (COMT) inhibitor)
4- Addition of ropinirole (a dopamine agonist)
5- Give the same total amount of l-dopa in 5 divided doses
Answer: 4- Addition of ropinirole (a dopamine agonist)
A 19-year-old college student is noted to seem confused by her flatmate. She has been complaining of a diffuse headache and general malaise for the past 24 hours. On examination she has a temperature of 38°C. She is restless and mildly dysphasic. The remainder of the general and neurological examination is normal. CT brain scan shows hypodensity in both temporal lobes. Cerebrospinal fluid (CSF) examination shows a white cell count of 16/ mm3 (lymphocytes), a slightly raised protein concentration of 0.75 g/l and a normal CSF/blood glucose ratio.
Which would be the most appropriate early management pending further diagnostic information?
1- Intravenous fluids, broad-spectrum antibiotics and prophylactic anticonvulsants pending further CSF analysis
2- Intravenous fluids, aciclovir and prophylactic anticonvulsants
3- Intravenous fluids, aciclovir and broad-spectrum antibiotics
4- Intravenous fluids, aciclovir and corticosteroids
5- Intravenous fluids and iv aciclovir
Answer: 5- Intravenous fluids and iv aciclovir
A 30-year-old pregnant woman presents with a weak grip and tingling of her right hand. She complains of a dull aching pain in her forearm, which is made worse by carrying a shopping bag. On examination you find weakness of the right abductor pollicis brevis and mild weakness of thumb flexion. Finger abduction and adduction appear to be within normal limits. There is sensory loss to pinprick mainly affecting the right thumb and index finger. Phalen’s sign is positive. The left-hand sensorimotor examination is normal. The deep tendon reflexes are symmetrical.
What is the most likely cause of her symptoms?
1- Compression of the right ulnar nerve at the elbow
2- Right C8 nerve root irritation
3- Right brachial plexopathy
4- Compression of the right median nerve in the forearm
5- Compression of the right median nerve in the carpal tunnel
Answer: 5- Compression of the right median nerve in the carpal tunnel
A 29-year-old woman with temporal lobe epilepsy wishes to have a baby. She is currently taking phenytoin 300 mg per day and lamotrigine 50 mg per day in combination. Her partial seizures have been controlled for 10 months. She has no history of generalised tonico-clonic seizures. She is already taking a multivitamin tablet containing folic acid as she has read that this is advised in early pregnancy. She is anxious about the risk of fetal malformations.
What would be the most appropriate advice to suggest regarding her management?
1- Once she is pregnant, start high-dose folic acid (5 mg per day)
2- Start high-dose folic acid now
3- Start high-dose folic acid now and try to withdraw one of her antiepileptic drugs (AED)
4- Try to reduce the dose of each AED and continue taking a multivitamin tablet
5- Try to reduce the dose of each AED and start high-dose folic acid
Answer: 3- Start high-dose folic acid now and try to withdraw one of her antiepileptic drugs (AED)