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Heaven ૮ ˶ᵔ ᵕ ᵔ˶ ა > Neuro/ENT > Flashcards

Neuro/ENT Flashcards

1
Q

Young Guy found at work with brief seizure (1-2 minutes jerking). Urine screen neg for drugs. Glucose 5.3. No focal neurological features? Now real disorientated. Obs okay. SO what are you going to do doc?

A young guy collapsed on the floor at work, work fellows reported some jerking movements in arms while he was on the floor. Eyes open on voice, able to follow single-step commands, but he is still confused. Normal vitals, no focal neurological signs. Negative urine drug screen. What investigation?

CT head
Blood alcohol
EEG
MRI

A

How young lol

EEG

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2
Q

Maori guy with blurry vision, pale optic disc, no pain leading up to it. what was the first investigation
MRI angiogram of neuro vessels
CT brain
US of carotids
ESR

A

This is optic neuritis ? GCA? No clue

Past cohort thinks ESR

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3
Q

Older lady with 3 days of left ear hearing loss (came on suddenly just after waking). Eardrum perforation repair in 20s, worked in noisy environment for 15 years when young. On exam Weber’s goes to right.
Acute sensorineural hearing loss
Chronic sensorineural hearing loss
Conductive hearing loss

A

Acute sensorineural hearing loss

e.g. over 3 days defines this

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4
Q

Patient with dysphagia originally to solids now too liquids. 15kg weight loss, cachexia, old woman and lower limb areflexia both ankles + some sensory loss.
Bulbar Palsy
Achalasia
Oesophageal Cancer

A

Oesophageal Cancer with cord compression

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5
Q

Lady stroke, can’t get dressed even though she can use limbs, inferior quadrantonopia, inattention and shit. Realises she has had a stroke but won’t say how this has affected her

Looks as though her left arm and leg are often in positions that appear uncomfortable. It had also affected her speech and there was a left inferior homonomous quadrantonopia. Left inattention on exam.
.
- Non-dominant parietal lobe lesion
- Vasc dementia
- Delirium

A

Non-dominant parietal lobe lesion

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6
Q

Old lady, developing short term memory loss, forgetting to turn the oven off, what area of the brain is affected?Speech was also affected.
Angular Gyrus+7 a guy with a neuro degree said it was this
Medial temporal lobe +11 - long term memory
Orbitofrontal complex +2
Parieto-occipital cortex +17

A

Literally no clue

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7
Q

Metalworker gets pain in eye and reduced vision. Which investigation?
a. Orbital x-ray
b. CT
c. MRI
d. angiography

A

CT

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8
Q

Guy gets hit in the eye in a fight, diplopia on upgaze, numbness on inferior rim/under eyelid. Bruising around the orbit and inferiorly. Cause?
a. Superior rectus haematoma
b. Entrapment of inferior rectus in fracture of orbital floor (trap door)
c. Retinal detachment
d. Periorbital bruising
e. Paresis of Trochlear nerve due to skull fracture

A

Entrapment of inferior rectus in fracture of orbital floor

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9
Q

Guy hit head and was all good for 40mins and then lost consciousness and the ambulance was called. BP super high, and HR low

a) SAH
b) Subdural haematoma
c) Extradural haemorrhage
d) Intracerebral bleed
e) Cerebral contusion

A

Extradural haemorrhage

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10
Q

Girl is playing soccer and has weakness and pin and needles in her right arm and then tingling on right face. She then has a severe unilateral left-sided pulsating headache for 3 hours and is nauseous but doesn’t throw up. Pain subsides and she is neurologically normal. what is going on?
A) Common migraine
B) Trigeminal neuralgia
C) Haemorrhagic stroke
D) Embolic stroke
E) Leaking aneurysm
F) Migraine with aura

A

Migraine with aura

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11
Q
  1. Lady with 3 months of recurrent episodes of shimmering in left visual field, lasts 10-20 minutes. Sometimes followed by severe global headache worse with exertion? diagnosis
    Migrainous aura
    Optic neuritis
    Occipital tumour
A

Migrainous aura

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12
Q

Young dude in MVA. Loss of movement, reflexes, vibration in right leg, loss of pain and temperature in the left leg. Where is the lesion?
Right hemicord
Left hemicord
Central cord

A

Right hemicord

Spinothalamic - pain + temp - spinal cord
Dorsal column - fine touch, vibration, proprioception - crosses over in medulla
Corticospinal - movement, crosses in medulla

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13
Q

Alcoholic man comes in with fractured tibia, gets repaired with internal fixation. Admits to drinking a bottle of vodka a day. A day later he becomes confused. Which other symptoms would most likely point towards acute thiamine deficiency?
a) Peripheral neuropathy
b) Seizure
c) Abnormal eye movement
d) Hallucination
e) Vomiting
f) Hypotension

A

Acute thiamine deficiency –> Wernicke’s encephalopathy, confusion, nystagmus, ataxia

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14
Q

Dude with T2DM with bilateral foot pain shooting from soles up to big toes in the night, not exacerbated by exercise. Tibialis and dorsalis pulses are normal with reduced cap refill on great toe. Normal power, Reduced ankle reflexes, proprioception inconclusive. Erythema over right forefoot and big toe. What test next?
a) Serum urate
b) CT lumbar spine
c) Further sensory examination
d) Foot x-ray
e) Doppler ultrasound of leg arteries

A

Further sensory examination
?Diabetic nephropathy

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15
Q

40 year old man with recurrent unilateral headaches occurring at night. Eyes and nose water on the same side. He would get up and walk around for 30-60 minutes and then they would go away. Had headaches like these a couple months previously which lasted a week then stopped. Diagnosis?
a) Migraine
b) Cluster headache
c) Tension headache
d) GCA

A

Cluster headache

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16
Q

Women with headache described as a “band tightening around her head”. Sometimes radiates bitemporally. Been taking paracetamol 2-3 times a week for this. No obvious triggers. Diagnosis?
a) Tension headache
b) Migraine
c) Medication overuse headache

A

Tension headache

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17
Q

Lady experiencing episodes of vertigo and nausea, this is worst when turning over in bed and moving her head. Best diagnostic test?
a) CT head
b) Romberg test
c) Dix-Hallpike manoeuvre
d) Tilt table test

A

Dix-Hallpike lay down off side of bed look for nystagmus

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18
Q

Man with 6-12 hours episodes of unilateral hearing loss and swooping noises with nausea, vomiting, vertigo (not related to head movement) and tinnitus. Started a few months ago, getting worse, now impacting ability to function. No neuro sx, normal neuro exam. Audiometry graph with sensorineural hearing in affected ear. What is the diagnosis?

A

Meniere’s disease

Fluctuating unilateral sensorineural hearing loss (SNHL)

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19
Q

Lady with 3 months of recurrent episodes of shimmering in left visual field, lasts 10-20 minutes. Sometimes followed by severe global headache worse with exertion. Diagnosis?
a) Migraine with aura
b) Optic neuritis
c) Occipital tumour

A

Migraine with aura

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20
Q

Young dude in MVA. Loss of movement, reflexes, vibration in right leg, loss of pain and temperature in the left leg. Where is the lesion?
a) Right hemicord
b) Left hemicord
c) Central cord

A

Right hemicord

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21
Q

22 year old pacific girl fell off her horse onto head. Has a head wound, head is wrapped with blood soaked bandages. She was conscious but drowsy. Initial management?

a) Secure airway
b) Lateral C spine X ray
c) Tend to the bleeding
d) MRI head
e) Give high flow oxygen

A

Secure airway

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22
Q

Guy hit head on pavement and 1 hour later lost consciousness, so ambulance was called. Came to and chatty. 40 minutes later deteriorated. Unconscious, BP 200/90, HR 50. Fixed and dilated pupil.
a) SAH
b) Subdural haematoma
c) Extradural haemorrhage
d) Intracerebral bleed
e) Cerebral contusion

A

Extradural haemorrhage

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23
Q

Alcoholic man comes into ED with confusion, nystagmus, seizures. History of drinking 2 bottles of wine a day for 10 years. He had diplopia in lateral and upwards gaze. Left eye couldn’t look down or outwards. No Hx of head trauma. Immediate management?
a) IV thiamine
b) Other vitamin infusions
c) IV Dextrose
d) CT head
e) Antibiotics

A

IV thiamine

Then do CT head next

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24
Q
A
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25
Q

Alcoholic guy with history of DUI has had nausea and headaches for past few weeks. Has bruises on face and hands from fights. Presenting with confusion, nystagmus, hyperreflexia, ataxia, ophthalmoplegia. Investigation?
a) CT head
b) LFTS
c) FBC
d) Blood alcohol level
e) Hand x-rays

A

CT head

26
Q

9 year old lady with persistent headaches for 6 months, getting worse, especially in last few weeks. Hx of migraines without aura but says that these headaches are different. Currently taking codeine, ibuprofen and sumatriptan multiple times daily, with no improvement. Increasing doses as headaches get worse. Also on COCP. Nil vomiting, nil other sx. Normal neuro on exam and everything else normal. BP 132/78. What to do?
a) Stop COCP
b) Rx metoprolol
c) Rx tramadol
d) Rx TCA
e) Stop taking pain meds (sumatriptan, paracetamol, ibuprofen)

A

Stop taking pain meds (sumatriptan, paracetamol, ibuprofen)

Overuse headaches
Do not use more than 10-15 days for headache

27
Q

Girl is playing soccer and has weakness and pin and needles in her right arm and then tingling on right face. She then has a severe unilateral left-sided pulsating headache for 3 hours and is nauseous but doesn’t throw up. Pain subsides and she is neurologically normal. Dx?
a) Common migraine
b) Trigeminal neuralgia
c) Haemorrhagic stroke
d) Embolic stroke
e) Leaking aneurysm
f) Migraine with aura

A

Migraine with aura

28
Q

Guy presents to GP with low back pain, leg pain and numbness, thinks he injured back lifting something heavy. Difficulty peeing, poor anal tone, saddle anaesthesia. Next step?
a) Request bloods
b) Review in 2-3 days
c) Prescribe paracetamol
d) Urgent referral to hospital
e) Referral to ortho outpatients
f) Xray of the lumbar spine
g) Request MRI of lumbar spine

A

Urgent referral to hospital

29
Q

Guy with balance problems, falling especially at night. He can balance with eyes open but unable to balance when he closes his eyes. Vestibulo-occular reflex (VOR) normal. Where is the problem?
a) Cerebellum
b) Peripheral sensory nerve
c) Peripheral motor nerve
d) Anterior cord lesion
e) Vestibular nerve

A

Describes a positive romberg test, where proprioception is lost but usually can compensate with vision

= peripheral sensory nerves

30
Q

Man with pain in legs on exertion. Is present in both legs. Can’t walk for more than 50m without pain coming on. No pain at night. Gets better after a period of rest and finds that leaning over his shopping trolley helps. All neuro exam findings were intact. ABPI 0.9. Cause?
a) Macrovascular disease
b) Microvascular disease
c) Spinal canal stenosis

A

Macrovascular disease

ABPI = ankle-brachial pressure index, a measure of peripheral artery perfusion… 1-1.4 is normal. <0.9 is peripheral arterial disease, 0.4 is critical limb ischaemia.

31
Q

Diabetic man, smoker. ABPI 0.6. Vascular claudication. What does he have?
a) Macrovascular disease
b) Microvascular disease
c) Spinal canal stenosis

A

Macrovascular disease

32
Q

Guy has a really long description of a migraine with aura (unilateral headache, throbbing pain, associated vomiting) since childhood. Wants a new medication to take at the start of a headache. Already on naproxen and paracetamol, they don’t really help though. What do you prescribe?

A

Triptan

33
Q

Kid fell off monkey bars and hit head. Remembers falling and hitting his head. GCS 15, vomited once and has a headache. Tenderness on frontal region.
a) Admit for neuro observation
b) CT head
c) Observe for 4 hours and discharge if neuro obs normal
d) Discharge with information about head injuries
e) Skull x-ray

A

Observe for 4 hours and discharge if neuro obs normal

Vomiting once is ok, severe headache? >4 hours consider CT

34
Q

Old lady with memory loss over 3 years, forgets words sometimes. Forgets to turn off the oven sometimes. What part of the brain would be affected.
a) Angular gyrus
b) Medial temporal lobe
c) Frontal lobe
d) Parieto-occipital cortex

A

Medial temporal lobe

  • Temporal lobe = memory
    o Hippocampus = part of medial temporal lobe - Parietal lobe = information, language, writing
    o Angular gyrus involved in memory
  • Frontal lobe = behavioural, executive function
  • Occipital lobe = object recognition
35
Q

Guy in MVA with lamp post. Broke tibia and chest injury. 3 days later acute confusion. Why?
a) Alcohol withdrawal
b) Subdural haematoma
c) Schizophrenia
d) Narcotic sensitivity

A

Subdural haematoma

36
Q

Man on cardiology ward. On second day develops difficulty talking. Replies with single words or short sentences only. Has trouble finding the right word, but usually gets his meaning across. What’s the problem?
a) Motor aphasia
b) Sensory aphasia
c) Dysarthria
d) Delirium

A

Motor aphasia = Brocas (broken speech, no issue understanding)

Sensory/receptive = Wernicke’s (cannot understand)

Dysarthria = MUSCLES are weak, not a brain issue

37
Q

Asked to copy and draw a picture of two intersecting pentagons in a cognitive assessment. Which
part of a)
b) c) d) e)
brain is she using?
Dominant parieto-temporal Non-dominant parieto-temporal Non-dominant parietal Hippocampus
Frontal lobe

A

I think non-dominant parietal

38
Q

Women was confused, headache, nausea and vomiting for 24 hours and she had a mildly stiff neck. What condition?
CTH: white (blood) in ventricles instead of black (CSF)
a) Subarachnoid haemorrhage
b) Meningicoccal meningitis
c) Cryptoccocus meningitis
d) Cerebral abscess
e) Closed head trauma

A

Subarachnoid haemorrhage

39
Q

Leg weakness. Left-sided chest pain when turning. Was having difficulty standing from sitting. Normal resp and breast exam. What investigation?
a) CT spine
b) CXR
c) Protein electrophoresis
d) Zoster swab

A

This is potentially multiple myeloma. But idk. UPE could be good.

40
Q

Sudden brain event. Symptoms on face one side, on body other side. Horner’s syndrome. Tongue deviation too? Diplopia. Has HTN. Diagnosis?
a) Vertebral artery occluded
b) Basilar artery occluded
c) Brain stem glioma
d) Infection or something else
e) Wernicke’s Encephalopathy
f) Cerebral artery occluded

A

Vertebral artery occluded

This is lateral medullary syndrome

41
Q

55 year old guy complaining of worsening handwriting. 4th and 5th digits loss of sensation, trouble gripping pen. What investigation do you do?
a) Nerve conduction study
b) CT neck
c) MRI brachial plexus
d) Wrist X-ray

A

Nerve conduction study

42
Q

Personality changes and confusion. Which lobe affected? a) Frontal
b) Parietal c) Temporal

A

Frontal

43
Q

Ptosis, pupil down and out, fixed dilated pupil. What is problem?
a) Oculomotor nerve palsy
b) Trochlear nerve palsy
c) Adbucens nerve palsy

A

Oculomotor nerve palsy

most muscles + pupil constrictor

44
Q

90 year old with stroke 5 hours ago. CT head ruled out haemorrhage. What is the immediate management?

A

5 hours - confirmed ischaemic.

Thrombolysis if <4.5 hours
Clot retrieval at discretion of consultant…. patient must be previously independant.

45
Q

Papilloedema. Headaches at night. Nystagmus on lateral gaze. Diagnosis?
a) Benign intracranial hypertension
b) Traumatic brain injury
c) Brain tumour

A

Benign intracranial hypertension

46
Q

Patient with mask like faces, slowness, difficulty to stop walking. Diagnosis?
a) Parkinson’s disease
b) Motor neuron disease
c) Multiple sclerosis

A

Parkinsons

47
Q

Female with ear infection develops Bell’s palsy. Treatment?
a) Prednisone
b) Prednisone + acyclovir
c)
Acyclovir

A

Can use steroids and antivirals

48
Q

Patient with hemiparesis and hypertension. Diagnosis?
a) Lacunar infarct
b) Thrombotic infarct
c) Embolic infarct
d) Haemorrhagic stroke

A

Think by far the most common stroke is ischaemic infarct

49
Q

Patient with head injury clear nasal discharge, swelling over the mastoid, bruising around eyes look like racoon. Diagnosis?
a) Basal skull fracture
b) Broken nose

A

Basal skull fracture –> disrupted dura

CSF leakage

50
Q

Loss of sensation (discriminative and non-discriminative) and burning pain in upper lateral thigh. Dx?
a) Meralgia paresthetica
b) Cauda equina syndrome

A

Meralgia paresthetica

MP = lateral femoral cutaneous nerve compressed 􏰀 tingling, numbness and burning pain outer thigh
- Causes: tight clothing, obesity or weight gain, pregnancy, trauma, diabetes

51
Q

Fall down in bath. Head injury due to seizure, reducing LOC. X-ray shows parietal bone fracture. Diagnosis?
a) Extradural hematoma
b) Subdural haematoma

A

MMA runs under pterion
–> epidural haemotoma

52
Q

Action tremor. Cause? a) Parkinson’s
b) Cerebellar
c) Essential

A

Cerebellar

PD - worst at rest
Essential - just ossicalations of hands, worse with anxiety or action

53
Q

Muscle aches in female worse in afternoon, feels refreshed after sleep. Dx? a) Myasthenia gravis
b) Fibromyalgia

A

Myasthenia gravis, autoimmune disorder against nAChR at NMJ. Relived with rest.

Fibromyalgia - gives non-restorative sleep

54
Q

Woman who presents with withdrawal seizure from alcohol. Treatment? a) Thiamine
b) Diazepam

A

Seizures –> diazepam

55
Q

​​Person on cardiology ward, on second day develops difficulty talking. Replies with single words or short sentences only. Has trouble finding the right word, but usually gets his meaning across. What’s the problem? (repeat q)
a. Motor aphasia
b. Sensory dysphasia/aphasia
c. Dysarthria

A

Motor aphasia +13

56
Q

girl has seizure in the morning, child aware and able to think

A

Myoclonic seizure

57
Q
  1. Pt has stroke, paralysis of left leg, no other signs, where is the lesion
    ACA, anterior spinal artery, PSA, MCA
A

ACA, on the right (middle part of the homonculus)

58
Q

20 year old female, decreased vision in right eye, normal iris, swollen disc, headache
worse with eye movement, decrease light reflex in right eye, colour vision decrease. what is
dx

A

Optic neuritis

59
Q

Case of amurosis fugax (curtain like visual loss)

A

Sign of impending stroke - aspirin or clopidergral.

If carotid stenosis - do a stent… etc. endartctomy only if >70%, invasive

60
Q

Mower on hot day, fell with no warning, then woke up right after and continued
mowing

A

Vasovagal

61
Q

Dizziness, vertigo, hearing problems

A

Acoustic neuroma

62
Q
A

Heaven ૮ ˶ᵔ ᵕ ᵔ˶ ა (27 decks)

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