neuro formative

Question 1

which spinal tract is responsible for exciting felxor muscles + inihibiting extensor muscles of the upper body

Answer 1

rubrospinal tract

Question 2

how would cervical myelopathy present

Answer 2

symmetrical weakness of legs, mild weakness of hands, abnormal gait
reflexes extrememly brisk in legs with upgoing planters bilaterally

(cervical herniation does not always cause cervical myelopathy)

Question 3

A 45 year old call centre worker is complaining of lumbar pain for the past two months. He gets stiffness in the morning and the pain gets worse on prolonged sitting and turning over in bed.

Answer 3

mechanical back pain

(NOT disc herniation lol obvs idiot)

Question 4

which vein can rupture between the dura + arachnoid

Answer 4

bridging vein

Question 5

between what layers does the posterior communicating artery anneurysm lie

Answer 5

between arachnoid + pia

Question 6

An 80-year-old ex-smoker with uncontrolled hypertension presented with the acute onset of numbness of his left arm and leg. On examination, there was decreased sensation to all his left side of the body and face. what type of stroke?

Answer 6

lucunar

Question 7

A 66-year-old female with atrial fibrillation presents with dysphasia and left hemiparesis. what type of stroke

Answer 7

partial anterior circulation infarct

Question 8

A 70-year-old male with left homonymous hemianopia. He has no other symptoms. what type of stroke

Answer 8

posterior circulation infarct

Question 9

Choose the investigation that would provide the definitive diagnosis:
A 70 year old patient presents with progressive headaches and nausea with gradual loss of sensation in her right arm. Imaging reveals a mass in the temporal lobe

Answer 9

biopsy

Question 10

A 25-year-old man developed a sudden onset ‘worst ever’ headache and collapsed - IX for definitive diagnosis

Answer 10

CTA
–> berry aneurysm causing SAH

Question 11

where is primary auditory cortex

Answer 11

superior temporal gyrus

Question 12

where is the oculomotor nucleus

Answer 12

midbrain

Question 13

According to the patient’s symptoms, where is the most probable location of these brain tumours:

1. A 7 year old boy presents with progressive headache, wide based ataxia and difficulty speaking. Imaging and biopsy confirms the presence of a pilocytic astrocytoma.

Answer 13

cerebellum

Question 14

According to the patient’s symptoms, where is the most probable location of these brain tumours:

A 56-year-old man presented to the hospital with a seizure. He had been complaining of headaches for the past several months and has been “bumping into things”. On examination, it was revealed that he has a left superior quadrantopia. Imaging and biopsy confirmed a Glioblastoma multiforme.

Answer 14

right temporal lobe

Question 15

According to the patient’s symptoms, where is the most probable location of these brain tumours:

A 40 year old right-handed accountant presents with difficulty in writing and that he “wasn’t as good with numbers as before”. On examination, he had a left-right disorientation. Imaging and biopsy confirmed the presence of a meningioma.

Answer 15

left parietal lobe

(left dominant lobe if right handed)

Question 16

Which one of the following is NHS standard of care for a symptomatic, easily accessible glioblastoma in a young, fit patient?

Answer 16

Maximal surgical debulking surgery
Temozolomide chemotherapy
Radiotherapy

Question 17

A 25-year-old man developed a severe headache and collapsed. Upon calling his name, he does not respond nor opens his eyes. However, when a painful stimulus is applied he internally rotates his shoulders and flexes his forearm and wrists while extending his legs. GCS?

Answer 17

5

Question 18

A 70-year-old woman presents with a headache and confusion, 4 weeks after she suffered from a fall. She opens her eyes spontaneously and moves her arms and legs when told to. GCS?

Answer 18

14

Question 19

A 20-year-old male presented to A&E after being in a car accident. Neurologic evaluation was as follows: he opened his eyes only to the sound of his name, he was able to localize to a painful stimulus but failed to move his arms and legs to command only. When asked where he was his reply was “my house to go”
GCS?

Answer 19

11

Question 20

A patient presents with unilateral pupil mydriasis that does not constrict to light following a car accident. On CT, an intracranial haemorrhage was identified. What is the most likely type of herniation?

Answer 20

uncal herniation

Question 21

What is the cause for this patient’s sensation and motor weakness:

A 39-year-old woman presented with severe headaches whenever she sneezed. She also had decreased sensation to pinprick over her upper back, shoulders, and upper arms. Her power in her arms was 2/5 but her lower body power was 5/5.

Answer 21

syringomyelia

(cape-like distribution)

Question 22

What is the most likely cause of this patient’s symptoms:

A 6-month-old girl presented with a head circumference rising from the 66th to the 99th percentile and failure to thrive. On examination, when the lids are retracted, the eyes look like they are sunsetting, and upward gaze is impaired.

Answer 22

non-communicating hydrocephalus due to aqueduct stenosis

Question 23

Choose the correct anatomical area that correlates to the following functions:
1. A 56-year-old man presents with a headache, severity 8/10 with associated nausea. On examination he has ptosis, and miosis.

Answer 23

internal carotid artery dissection

Question 24

Choose the correct anatomical area that correlates to the following functions:

2. A 56-year-old man presents with a progressive headache, severity 6/10 with associated nausea. On examination he has ptosis, and a right dilated unreactive eye.

Answer 24

Posterior communicating artery aneurysm

(oculomotor nerve travels directly from the brainstem to the eye in a straight line. It travels through the cavernous sinus and close to the posterior communicating artery)

closed angle gluc would probs be more sore

Question 25

What is the most likely diagnosis in the following cases:

1. A 40-year-old obese lady on the contraceptive pill develops headaches first thing in the morning which are worse on coughing. She is complaining of double vision. What could be causing her diplopia?

Answer 25

CN VI palsy

most common causes of sixth nerve palsy are high blood pressure, diabetes, TIA (transient ischemic attack/mini stroke) or stroke.

Question 26

What is the most likely diagnosis in the following cases:

2. A 55 year old man develops diplopia after a closed head injury accident. He says the diplopia is worse when he is going down the stairs. On examination, you see he has a head tilt to the right.

Answer 26

CN IV

worse going down stairs **

Question 27

A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?

Answer 27

multiple sclerosis

Question 28

holmes adie pupil

Answer 28

unilateral dilated pupil that is sluggish to react to light with slow dilation of the pupil following constriction

caused by damage to post-ganglionic parasympathetic fibres

holmes adie syndrome = pupil + absent ankle + knee reflexes

Question 29

argyll-robertson pupil

Answer 29

specific finding in neurosyphilis
- a constricted pupil that accomodates when focusing on a near object but DOES not react to light

(prostitutes - it accommodates but does not react)