Neuro Questions Flashcards
James is a 17 year old electrician assistant. He presented via A&E after passing out at work three hours ago. His manager saw the incident, in which he collapsed to the floor limply. He came around 15 seconds later and felt very fatigued after regaining consciousness that has persisted until now. James doesn’t remember anything about the incident, he had no noticeable palpitations or dizziness prior to the event. He has no other past medical history of note, and currently takes no medication.
OE: HR 62, BP 125/92, RR 12, SaO2 99%, 36.5oC
CVS: normal, Resp: normal, GI: normal
Neuro: no gross abnormality
What is best first line medication indicated in this case
Atenolol Phenytoin Sodium Valproate Levetiracetam Ethosuximide
Sodium valproate
Emma is a 31 year old sales advisor who recently moved to Bristol from her childhood home in Glasgow. She presented to her GP with sudden onset painless loss of vision in her right eye. She has no other past medical history of note and is on the combined oral contraceptive pill. She has no known drug allergies and her family history is unremarkable.
OE: HR 92, BP 105/82, RR 16, SaO2 97%, 36.8oC
CVS: normal, Resp: normal, GI: normal
Neuro: Relative Afferent Pupillary Defect, Weakness in left leg (4/5)
What is the most likely investigative finding in this individual:
Oligoclonal Bands in CSF on LP Subdural Blood on CT Anterior Cerebral Aneurysm on MRI Anti-dsDNA and positive ANA Blood test A Decreased Velocity Nerve Conduction Study
Oligoclonal Bands in CSF on LP
An 80-year-old woman has presented to her GP as she thinks she has developed a problem with her vision. She sits in her chair most of the day and has noticed when she looks at her clock on the wall, she has to ask her carers for the time as she cannot see the time on the clock between 3pm and 6pm
OE: HR 62, BP 125/92, RR 12, SaO2 99%, 36.5oC
Where is the location of the lesion?
a) Left Temporal Lobe
b) Right Temporal Lobe
c) Left Parietal Lobe
d) Right Parietal Lobe
e) Occipital Lobe
Left Parietal Lobe
remember PITS
John is a 43 year old researcher at the University of Bristol. He presented to A&E after a sudden onset headache at work one hour ago. He describes the pain as intense stabbing pain and rates it 10/10. He has felt nauseous since the incident and has thrown up both at work and in the ambulance. He has no significant past medical history but has poor health seeking behaviour having avoided doctors all his life. He takes no medication and says he has a very stressful job.
OE: HR 106, BP 194/132, RR 19, SaO2 98%, 36.5oC
He is covering his eyes with his arm and looks to be in significant pain
CVS: normal, Resp: normal, GI: normal
Neuro: cant test CNII, III, IV, VI due to severe photophobia, otherwise normal.
What is the most likely diagnosis and initial management:
Hypertensive Encephalopathy + IV Labetalol
Meningitis + Empirical Antibiotics
Giant Cell Arteritis + Prednisolone
Cluster Headache + 100% Oxygen
Subarachnoid Haemorrhage + Neuro ICU Referral
Subarachnoid Haemorrhage + Neuro ICU Referra
A 20-year-old woman was admitted overnight with suspected meningitis. You are asked to review the initial microscopy results from the lumbar puncture. The lab tells you the culture is growing gram negative diplococci.
What is the most likely organism?
Strep pneumoniae Listeria E. coli H. influenzae Neisseria meningitidis
Neisseria meningitidis
A 44-year-old man was admitted to the medical unit with vomiting, drowsiness and headache. On examination he was febrile, squinting to bright lights and had severe pain when extending his knee when his hip was lifted off the bed. He was started on IV cefotaxime and IV dexamethasone and underwent a lumbar puncture.
What is the most common long-term complication of this condition?
encephalitis
hydrocephalus
sensorineural hearing loss
seizures
Sensorineural hearing loss is the most common complication following meningitis
A 31-year-old woman presents to the Emergency Department complaining of a headache. She has had ‘flu’ like symptoms for the past three days with the headache developing gradually yesterday. The headache is described as being ‘all over’ and is worse on looking at bright light or when bending her neck. On examination her temperature is 38.2º, pulse 96 / min and blood pressure 116/78 mmHg. There is neck stiffness present but no focal neurological signs. On close inspection you notice a number of petechiae on her torso. She has been cannulated and bloods (including cultures) have been taken. What is the most appropriate next step?
IV cefotaxime
arrange CT head
perform LP
IV dexamethasone
IV cefotaxime
A 59-year-old man with no significant past medical history is admitted to hospital following an ischaemic stroke. He presented outside of the thrombolysis window and is treated with aspirin for the first few days. His blood pressure is 130/80 mmHg, fasting glucose is 5.6 mmol/l and fasting cholesterol is 3.9 mmol/l. He makes a good recovery and has regained nearly all of his previous functions upon discharge. Following recent NICE guidelines, which of the following medications should he be taking upon discharge (i.e. after 14 days)?
Aspirin + statin
Aspirin + dipyridamole + statin
Clopidogrel + statin
aspirin + dipyridamole
Clopidogrel + statin
A 71-year-old man is reviewed following an ischaemic stroke. He is known to be intolerant of clopidogrel. What is the most appropriate therapy to help reduce his chance of having a further stroke?
warfarin
aspirin lifelong
aspirin + dipyridamole lifelong
dipyridamole. stop after 2 yrs
aspirin + dipyridamole lifelong
The 2-year limit has now been removed.
A home visit is requested by the husband of a 71-year-old woman who is ‘off her legs’. On arriving the patient states that since mid-morning her left arm has felt weak and a degree of facial asymmetry is noted when she smiles. She is normally fit and well other than a past history of hypertension for which she takes ramipril. What is the most appropriate action?
- dial 999 for emergency admission
- arrange review at TIA clinic
- dial 999 + give aspirin 300mg
- arrange review at TIA clinic + give aspirin 300mg
dial 999 for emeergency
Aspirin should only be given once a haemorrhagic stroke has been excluded
You review a 70-year-old woman four days after she was admitted with a suspected stroke. Unfortunately she has been left with right sided sensory loss affecting her arms more than the legs and a right sided homonymous hemianopia. Functionally she has difficulty dressing her self. Examination of her cranial nerves is unremarkable. What area is the stroke most likely to have affected?
Middle cerebral artery lacunar anterior cerebral artery posterior cerebral artery posterior inferior cerebral artery
middle cerebral artery
A 65-year-old male presents with sudden onset hemiparesis affecting the right face, arm and leg. The symptoms started approximately 12 hours ago. On examination you note right sided hemiparesis, aphasia, and a right homonymous hemianopia. A CT scan confirms left sided ischaemic stroke. An ECG demonstrates an irregularly irregular rhythm with absence of P waves. He has has a CHA2DS2-VASc Score of 4.
What is the most important initial treatment to provide?
clopidogrel LMWH Warfarin aspirin thrombolysis
aspirin
A patient arrives at the emergency department with right-sided hemiplegia, facial weakness and is having difficulty with speech. You suspect a stroke. Which of the following is the recommended tool used to assess a patient in this situation?
CHA2DS2VASC ROSIER ABCD2 FAST FRAX
ROSIER
ROSIER is an acronym for ‘Recognition Of Stroke In the Emergency Room’. It is the tool recommended by NICE to assess stroke symptoms in an acute setting
A 66-year-old man comes to see you as he has had numbness in his right hand which has gradually progressed over 48 hours and now he reports that the whole of his right-hand side is numb. You suspect that he is having a stroke and arrange a blue-light ambulance. 6 weeks later he comes to see you to thank your for your help and also discuss his medications.
Assuming there are no contraindications, which one of the following antiplatelet regimens is recommended following an acute ischaemic stroke?
Aspirin 300mg for 14 days then clopidogrel 75mg to be continued long term
A 72-year-old woman with a past history of treated hypertension presents for review. Yesterday she had a 2 hour episode where she couldn’t find the right word when speaking. These symptoms have now fully resolved. This has never happened before and there were no associated features. Neurological examination is unremarkable and blood pressure was 150/100 mmHg. Her only current medication is amlodipine. What is the most appropriate management?
aspirin 300mg immediately + specialist review in 2 weeks
aspirin 300mg immediately + specialist review within 24 hours
aspirin 300mg immediately + specialist review within 24 hours
