Nervous Flashcards
1. What is the most likely vessel damaged in an Extradural Haemorrhage? A) Opthalmic Artery B) Middle Cerebral Artery C) Middle Meningeal Artery D) Emissary Veins E) Bridging Veins
C) Middle Meningeal Artery
68 year old woman comes in with headache, blurred vision and sleepiness. Recovering alcoholic and has past medical history of falls. Examination reveals papilloedema and GCS of 12. On CT crescent shaped haemorrhage is identified that is not limited by cranial sutures.
Given more likely diagnosis what damaged vessel describes three signs and symptoms?
a) Emissary veins
b) Bridging Veins
c) Middle Meningeal Artery
d) Middle Cerebral Artery
e) Opthalmic Artery
b) bridging veins
A 57-year-old female attends the emergency department with a sudden onset of a severe occipital headache and has vomited 3 times in the past hour. An urgent CT scan finds no abnormalities, however, a lumbar puncture taken 12 hours later is positive for xanthochromia What is the most likely diagnosis? a) Subarachnoid Haemorrhage b) Intracerebral Haemorrhage c) Extradural Haemorrhage d) Subdural Haemorrhage e) Diffuse Axonal Injury
Subarachnoid Haemorrhage
A SAH is diagnosed. Urgent neurosurgical review is requested and a CT cerebral angiography indicates a posterior communicating artery aneurysm as the cause of the SAH. The patient is otherwise fit and well.
Which option is most likely to be the optimal treatment for the aneurysm?
a) Insertion of extraventricular drain
b) Coiling by interventional neuroradiologist
c) Extracranial intracranial bypass
d) Nimodipine only
e) Surgical clipping
b) Coiling by interventional neuroradiologist
All of the following are classical clinical features found in Parkinson’s Disease except? a) Bradykinesia B) Intention Tremor C) Cogwheel Rigidity D) Micrographia E) Anosmia
B) Intention Tremor
What test would not be useful in determining an organic cause of dementia? a) Glucose B) Thyroid Function tests C) Neuroimaging D) Vitamin B12 E) Nerve Conduction Studies
E) Nerve Conduction Studies
Which of the following diseases is Parkinsonism not a feature? a) Progressive Supranuclear Palsy B) Lewy body Dementia C) Multiple System Atrophy D) Normal Pressure Hydrocephalus E) Wilson’s Disease
D) Normal Pressure Hydrocephalus
All the following medications are used in the treatment of parkinson’s disease except? a) COMT b) MAO-B C) Atypical Antipsychotics D) Dopamine Receptor Agonists E) Levodopa
C) Atypical Antipsychotics
In which of the following conditions is dementia not a feature? a) Alzheimer’s Disease B) Huntingtons C) CJD D) Pick’s Disease e) Generalised Epilepsy
e) Generalised Epilepsy
A 71 year old man has progressive loss of short term memory. He has been experiencing visual hallucinations and is embarrassed to admit this. While the GP is talking to him she realises his right hand has a resting tremor a) Vascular B) Lewy Body C) Fronto Temporal D) Alzheimers
Lewy body
Jim is 57year old man who has come to the GP with his husband. His husband has noticed that Jim has been more aggressive and is exhibiting inappropriate behaviours when they are out in public. As the GP you ask about memory loss and there is no mention of any impairment. They are both worried about the gradual change in personality a) Vascular B) Lewy Body C) Fronto Temporal D) Alzheimers
Fronto Temporal
Margaret is a 78 year old woman who has presented to the GP with some concerns about her memory. Her husband has come with her today and he says that over the last 3 years she has had some sudden deteriorations, where he has noticed she has got considerably worse in a short period of time. BUt then she stays stable after these drops. She has a history of difficulty controlling her hypertension a) Vascular B) Lewy Body C) Fronto Temporal D) Alzheimers .
Vascular
A 85 year old man comes to the GP with a 12 month history of gradual decline in memory. His daughter has urged him to come to the doctor to get checked over as he is forgetting appointments, and even how to do some simple tasks that he has done his whole life eg. cooking his famous macaroni a) Vascular B) Lewy Body C) Fronto Temporal D) Alzheimers
Alzheimers
Which of the following is the most common primary tumour in adults?
a) Medulloblastoma
b) Ependymoma
c) Glioblastoma Multiforme
d) Cranipharyngioma
e) Meningioma
c) Glioblastoma Multiforme
On a CT head of a 50 year old patient a tumour is identified in the cerebellum. Which of the following might you elicit in examination of this patient? (Select all that apply)
a) Hypotonia
b) Intention Tremor
c) Slurred Speech
d) Hearing Loss
e) Past Pointing
f) Nstagmus
g) Dysdiachochokinesia
h) Ataxia
i) Dementia
j) Visual Problems
A Hypotonia C Slurred Speech E Past Pointing F Nystagmus G) Dysdiachocokinesia H) Ataxia J Visual Problems
Which of the following subtypes of brain tumour does not fall under the umbrella term of a ‘Glioma’?
a) Astrocytomae)
b) Oligodendroglioma
c) Glioblastoma Multiforme
d) Ependymomas
e) Meningoma
e) Meningoma
Select all options from the list below that describe the pathological features of a meningioma
a) Majority Benign
b) Compression symptoms rather than direct invasion
c) Respond to chemotherapy
d) Arise from dura mater
e) Majority Malignant
d) Arise from dura mater
Which of the following primary cancers does not commonly metastasise to the brain?
a) Renal
b) Breast
c) Pancreatic
d) Colorectal
e) Lung
Pancreatic
Which of the following is the most common malignant tumour in children?
a) Glioblastoma Multiforme
b) Pilocytic Astrocytoma
c) Cranipharyngioma
d) Medullablastoma
e) Meningoma
d) Medullablastoma
Which type of herniation syndrome is most worrying as it can cause cardiovascular and respiratory compromise?
a) Subfalcine (Supratentorial)
b) Central (Supratentorial)
c) Transtentorial (Supratentorial)
d) Tonsillar (Infratentorial)
e) Transcalvarial (supratentorial)
d) Tonsillar (Infratentorial)
In uncal herniation (transtentorial herniation) which concerning clinical sign may be elicited on examination?
a) Ipsilateral constricted pupil
b) Up and in position of ipsilateral eye
c) Down and out position of ipsilateral
d) Bitemporal hemianopia
e) Adduction of ipsilateral eye
c) Down and out position of ipsilateral
Which of the following would you NOT test for in a test for brain stem death? Select one or more
a) Patellar tendon reflex
b) Oculovestibular reflex
c) Pupillary light reflex
d) Respiratory effect on discontinuation of ventilation
e) Corneal reflex
f) Supraorbital pressure response
g) Gag reflex
h) Babinski reflex
A) Patellar Tendon Reflex
H) Babinski Reflex
What is the criteria for brain stem death testing? Tick all that apply:
a) Reversible causes excluded
b) Normal electrolytes
c) Deep coma of unknown cause
d) No sedation
a) Reversible causes excluded
c) Deep coma of unknown cause
A few days later, the patient has deteriorated and you go to speak to the family to explain that the patient is in a coma and you think it is time to start thinking about brain stem death testing.
Who can test Brain Stem Death?
a. 2 doctors, with at least 1 a consultant and both with experience of BSDT and at least 5 years PG experience, with testing taking place on 2 separate occasions
b. GP and Consultant together
c. 3 doctors, with at least 2 being consultants
d. A member of the transplant team
e. FY1 supervised by CT2
a. 2 doctors, with at least 1 a consultant and both with experience of BSDT and at least 5 years PG experience, with testing taking place on 2 separate occasions
A 35 year old male was involved in a head on collision with a tractor whilst riding his motorbike through the country roads in Aberdeenshire. He was airlifted to ARI where he was initially seen by the consultant in A+E resus. He is now in ICU and as the registrar in Neurosurgery you have been asked to go and assess him. He does not open his eyes and is unresponsive when you speak to him. He extends his right elbow, internally rotates his shoulder and flexes his elbow in response to pain.
What is his GCS?
a) 4
b) 9
c) 15
d) 3
9
From the list below state whether the disease would cause a Mydriasis (dilated pupi) or Miosis (constricted pupil)
a) Raised Intracranial Pressure
Mydriasis
From the list below state whether the disease would cause a Mydriasis (dilated pupi) or Miosis (constricted pupil)
b) Pilocarpine
Miosis
From the list below state whether the disease would cause a Mydriasis (dilated pupi) or Miosis (constricted pupil)
c) Stimulants such as Coccaine
Mydriasis
From the list below state whether the disease would cause a Mydriasis (dilated pupi) or Miosis (constricted pupil)
d) Cluster headaches
Miosis
From the list below state whether the disease would cause a Mydriasis (dilated pupi) or Miosis (constricted pupil)
E) Horner Syndrome
Miosis
