Diagnosis- Neurology Flashcards
A CT-head is taken of a 2-week year old baby. Healthcare professionals have been informed that the mother had not been taking folate tablets as prescribed, during the pregnancy. Using the image to the right, what is the underlying pathology?
A) Brain abscess
B) Encephalitis
C) Anencephaly
D) Arnold-Chiari Malformation
A) Brain abscess
B) Encephalitis
C) Anencephaly
D) Arnold-Chiari Malformation
Arnold-Chiari Malformation is a congenital birth defect which results in a larger-than-normal foramen magnum. This allows for potential herniation of the cerebellum leading to a blockage of CSF flow between ventricles and hence raised intercranial pressure. It is therefore a cause for non-communicating hydrocephalus. Arnold-Chiari Malformation is associated heavily with meningomyeloceles (a type of spina bifida) and syringomyelia.
A 43-year-old male presents to the clinic complaining of weakness in his arms and legs. He has been losing muscle mass over the past couple years despite weightlifting. He also notes that his mother had similar muscle wastage before she died of myocardial infarction at the age of 60.
A) Guillain-Barre Syndrome
B) Myotonic dystrophy
C) Hypothyroidism
D) Duchenne muscular dystrophy
A) Guillain-Barre Syndrome
B) Myotonic dystrophy
C) Hypothyroidism
D) Duchenne muscular dystrophy
Myotonic dystrophy is a type of muscular dystrophy characterised by gradually worsening muscle loss and weakness. Other symptoms may include cataracts and heart conduction problems. It is a type of anticipation disorder, associated with the triplet repeat CTG. Anticipation disorders generally have earlier onset and increased severity of symptoms with each generation.
A 64-year-old patient presents with muscle weakness of the limbs. They are an ex-smoker and have recently been diagnosed with lung cancer. The patient finds it difficult climbing up the stairs and has drooping of the eyelids and difficulty swallowing when eating food. They note that the muscle weakness gets better after warming up during physical exertion.
A) Hyperthyroidism
B) Clostridium tetani infection
C) Lambert-Eaton Myasthenic syndrome
D) Charcot-Marie-Tooth Disease
A) Hyperthyroidism
B) Clostridium tetani infection
C) Lambert-Eaton Myasthenic syndrome
D) Charcot-Marie-Tooth Disease
Lambert eaton myasthenic syndrome is the correct answer as it would present with muscle weakness that gets better after warming up. Drooping of eyelids similar to myasthenia gravis is also present. Lambert eaton is also heavily associated with small cell lung cancer – removing the cancer will cure the myasthenia gravis. Small cell lung cancer can also lead to excess ACTH secretion leading to cushing’s syndrome.
You are a F1 junior doctor working in A&E. A 76-year-old female patient presents herself following a car accident. The patient has slurred speech and is vomiting. A Glasgow coma score is calculated to be 11/15. A CT-Head is ordered immediately. After reviewing the image, what are you concerned about with this lady?
A) Subdural stroke
B) Epidural stroke
C) Brain abscess
D) Large vessel ischaemic stroke
A) Subdural stroke
B) Epidural stroke
C) Brain abscess
D) Large vessel ischaemic stroke
Subdural stroke is the correct answer as it appears concave in shape on head CT. It is caused by a shearing of bridging veins in the subdural space. This leads to a build-up of blood (haematoma) in the subdural space – giving symptoms of a space occupying lesion. Subdural strokes are more likely in patients with atrophied brains (e.g. elderly, alcoholics or those with Alzheimer’s) who have experienced some mild trauma such as a fall or whiplash in a car accident.
A 56-year-old male patient walks into clinic at an extremely slow pace and almost falls over when walking into the consultation. You notice that he has a resting tremor and struggles to initiate movement when he reaches for his list of medications. What is the location of the underlying pathology?
A) Brainstem
B) Pars reticularis of the substantia nigra
C) Pars compacta of the substantia nigra
D) Cerebellum
A) Brainstem
B) Pars reticularis of the substantia nigra
C) Pars compacta of the substantia nigra
D) Cerebellum
A 47-year-old male patient presents to the opticians with a BMI of 37 and a last known blood pressure of 157/93. The patient’s eyesight is also poor. These findings have been progressively getting worse due to the lifestyle habits of the patient. On fundoscopy the following is found:
What is the most likely underlying pathology?
A) Diabetes Mellitus type 2
B) Age-related macular degeneration
C) Retinal detachment
D) Central retinal artery occlusion
A) Diabetes Mellitus type 2
B) Age-related macular degeneration
C) Retinal detachment
D) Central retinal artery occlusion
The correct answer is Diabetes Mellitus type 2 as the fundoscopy shows cotton wool spots which are present in diabetic retinopathy.
A patient presents with bitemporal hemianopia which has developed over a couple weeks. What is the most likely underlying pathology?
A) Retinoblastoma
B) Optic nerve tumour
C) Pituitary tumour
D) Posterior cerebral artery occlusion
A) Retinoblastoma
B) Optic nerve tumour
C) Pituitary tumour
D) Posterior cerebral artery occlusion
Pituitary Tumour is the correct answer as this is what causes bitemporal hemianopia. The pituitary lies between the two internal carotids.
An otherwise healthy, 59-year-old female patient comes in with memory loss. Her husband argues that she has not been behaving the same recently and has been irregularly abusive at random points during the day. An MRI scan is arranged revealing ventricular enlargement. What is the most likely underlying pathology?
A) Alzheimer’s Disease
B) Lewy Body Dementia
C) Frontotemporal Dementia
D) Vascular Dementia
A) Alzheimer’s Disease
B) Lewy Body Dementia
C) Frontotemporal Dementia
D) Vascular Dementia
The correct answer is frontotemporal dementia (also known as Pick Body Dementia) which leads to classical personality changes (often before the onset of memory loss). The key is in the history of presenting complaint.
Patient presents with ptosis, anhidrosis and meiosis. She is also breathless and has lost 10kg in weight over the past couple months. What is the most likely underlying pathology?
A) Pancoast lung tumour
B) Cystic Fibrosis
C) Intracerebral stroke
D) Oculomotor nerve lesion
A) Pancoast lung tumour
B) Cystic Fibrosis
C) Intracerebral stroke
D) Oculomotor nerve lesion
Squamous cell carcinomas are most likely to be in the Pancoast region of the lung. Pancoast lung tumours can compress on the sympathetic chain of the spine leading to Horner’s syndrome. Horner’s syndrome is the triad of symptoms; ptosis, anhidrosis and meiosis.
A 19-year-old male presents to A&E after being stabbed with a katana through the right side of the chest, piercing straight through the back leading to a hemi-section of the spine. He miraculously survives however has a loss of pain sensation. Where would he experience this loss of pain?
A) Ipsilaterally to the lesion (Right side)
B) Contralaterally to the lesion (Left side)
C) Bilaterally to the lesion (Both sides)
D) No pain loss
A) Ipsilaterally to the lesion (Right side)
B) Contralaterally to the lesion (Left side)
C) Bilaterally to the lesion (Both sides)
D) No pain loss
This question assesses whether you can spot the identify the pattern of nerve damage present in brown-Sequard syndrome. Although a theoretical lesion (as no real-life injury or condition will ever result in a perfect hemi-section) the question is a common exam hot topic. Hemi-section of the spinal cord results in paralysis and loss of proprioception on the same (or ipsilateral) side as the injury or lesion, and loss of pain and temperature sensation on the opposite (or contralateral) side as the lesion
