Neuro Formative

Question 1

An 80 yearold man presents to his GP with a gradual onset of walking difficulties, urinary incontinence and cognitive decline. He has no headache. What are these symptoms most typical of?

Answer 1

Normal pressure hydrocephalus

wet, wacky and wobbly

Question 2

Treatment of normal pressure hydrocephalus

Answer 2

Ventriculoperitoneal (VP) shunt

Question 3

Types of hydrocephalus

Answer 3

Communicating (normal pressure) - difference in CSF production:drainage ratio
Non-communicating (obstruction)

Question 4

A 50 year old right handed barman presents with cognitive language dysfunction. He has difficulty expressing what he wishes to say and difficulty reading emails. What is the most likely explanation for these findings?

Answer 4

Lesion in left temporo-parietal area

Question 5

A 69 year old man with left sided neglect. which structure is most likely to be affected?

Answer 5

Right parietal lobe

Question 6

Oligodendrocytes

Answer 6

Form myelin sheaths in CNS

Question 7

Schwann cells

Answer 7

Myelination of PNS

Question 8

What organism is responsible for syphilis?

Answer 8

Treponema pallidum

Question 9

Borrelia burgdorferi

Answer 9

Lyme disease

Question 10

Features of an UMN lesion

Answer 10

Spasticity
Hypertonia
Sustained clonus
Hyperreflexia

Question 11

Which artery supplies the left internal capsule?

Answer 11

Left middle cerebral artery

Question 12

What suggests a vascular aetiology of dementia?

Answer 12

Stepwise progression

Question 13

A 47 year old woman presents to A&E with severe back pain and urinary retention. She is numb around her perineum and has absent ankle jerks. What is the likely diagnosis?

Answer 13

Cauda Equina syndrome

Question 14

How is Gerstmann’s syndrome characterised?

Answer 14

Dysgraphia/agraphia (deficiency in the ability to write)
Dyscalculia/acalculia (difficulty in learning or comprehending mathematics)
Finger agnosia (inability to distinguish the fingers on the hand)
Left-right disorientation

Question 15

Cause of Gerstmann’s syndrome

Answer 15

Lesion in dominant (usually left) hemisphere, near temporo-parietal junction

Question 16

Guillain Barre syndrome

Answer 16

Immune system attacks healthy nerve cells of the PNS, leading to weakness, numbness, and tingling, and can eventually cause paralysis

Question 17

Lumbar radiculopathy

Answer 17

Normally caused by compression of spinal nerve root manifesting as pain, numbness, or weakness of the buttock and leg (sciatica)

Question 18

A 47 year old man was referred to a neurosurgeon with a spinal cord tumour. The tumour was compressing his posterior (dorsal) columns on the right hand side. There is likely to be loss of ___ sensation below the level of the lesion on the ___ side

Answer 18

Vibration and proprioception

Ipsilateral

Question 19

Up which tract do pain and temperature travel?

Answer 19

Lateral spinothalamic

Question 20

What is erythrocyte sedimentation rate?

Answer 20

The rate at which red blood cells in whole blood descend in a standardized tube in a period of one hour.
Increased in inflammation

Question 21

A 55 year old woman presents to her GP with a headache which is associated with scalp tenderness over the right temporal artery. The GP diagnoses giant cell arteritis and commences treatment. What laboratory result would be expected with this condition? (ESR)

Answer 21

Elevated ESR

Question 22

Which neurotransmitter is affected in Parkinson’s?

Answer 22

Dopamine

Question 23

Differential diagnosis of three previous episodes of loss of consciousness

Answer 23

Epileptic fit
Syncope
Hypoglycaemia
Cardiac arrhythmia

Question 24

Symptoms of epilepsy

Answer 24

Aura/warning symptoms
Witness account of tonic/clonic seizure
Tongue biting
Urinary incontinence
Slow recovery
Family history

Question 25

Tonic stage of seizure

Answer 25

You lose consciousness, your body goes stiff, and you may fall to the floor

Question 26

Clonic stage of seizure

Answer 26

Your limbs jerk about, you may lose control of your bladder or bowel, you may bite your tongue or the inside of your cheek, and you might have difficulty breathing

Question 27

Dysphagia

Answer 27

Difficulty swallowing

Question 28

Dysarthria

Answer 28

Slurred speech

Question 29

Myasthenia gravis

Answer 29

Interruption of nerve impulses at NMJ

Question 30

Signs on examination of Guillain Barre but not myasthenia gravis

Answer 30

Areflexia
Sensory loss
Muscle wasting

Question 31

Signs on examination of myasthenia gravis but not motor neuron disease

Answer 31

Ptosis
Opthalmoplegia
Fatiguability (varying in severity from hour to hour)

Question 32

What is the most likely cause of Guillain Barre syndrome?

Answer 32

Post infectious immune response

Question 33

With damage to the pyramidal tract at the right internal capsule, which side of the body would be affected? Would there be sensory or motor loss?

Answer 33

Left side

Motor

Question 34

Where does the pyramidal tract originate from?

Answer 34

Precentral gyrus

Question 35

Name two areas that deal with language and speech

Answer 35

Broca’s area (language processing, frontal lobe)

Wernicke’s area (comprehension of speech, temporal lobe)

Question 36

Name two areas that deal with language and speech

Answer 36

Broca’s area (production of speech, frontal lobe)

Wernicke’s area (comprehension of speech, temporal lobe)

Question 37

Causes of subarachnoid haemorrhage

Answer 37

Life threatening type of stroke
Ruptured aneurysm
Arteriovenous malformation
Head injury

Question 38

CT of head with convex lens shaped bleed

Answer 38

Extradural haematoma

Question 39

CT of head with bleed within the brain (discrete)

Answer 39

Subarachnoid haemorrhage

Question 40

CT of head with kinda wonky bleed lining the skull

Answer 40

Subdural haematoma

Question 41

CT of head with large bleed within the brain

Answer 41

Intracerebral haemorrhage