Neurological

Question 1

A 45yo male presents with a worsening headache associated with hypertension, bradycardia and bradypnoea

Answer 1

Raised ICP

Question 2

A 60yo patient with CVD risk factors presents with a 4 hour history of unilateral weakness in her left arm and leg with associated sensory disturbance

Answer 2

TIA

Question 3

A 60yo patient with CVD risk factors presents with a 36 hour history of unilateral weakness in her left arm and leg with associated sensory disturbance. There is also an associated aphasia

Answer 3

Cerebral infarction (MCA)

Other presentations:

• ACA: contralateral hemisensory loss and hemiparesis of the lower limb
• PCA: contralateral hemonymous hemianopia

Question 4

A 60yo patient with CVD risk factors and long-standing HTN presents with a headache with associated neck stiffness and photophobia. Over time, the patient develops Cushing’s triad and a unilateral dilated pupil

Answer 4

Intracerebral haemorrhage

Question 5

A 60yo patient with CVD risk factors presents an acute onset headache, described as the worst she’s ever had a like being kicked in the back of the head. She has a family history of sudden death

Answer 5

Subarachnoid haemorrhage

Question 6

A 55yo patient presents with generalised muscle weakness and wasting. Generalised fasciculations are noted and reflexes are brisk. There are no sensory complaints

Answer 6

MND

Question 7

A 90yo woman with dementia presents with acute onset inattention and altered level of consciousness. Her daughter says her state has been fluctuating and is unsure if she has an infection

Answer 7

Delirium

Precipitating factors: medications, multiple medical problems, infection, surgery, substance withdrawal, acute brain pathology

Question 8

A 70yo male presents with progressive tremor and bradykinesia. On further questioning he admits to some constipation. On examination he has a characteristic gait that shows en block turning

Answer 8

Parkinson’s disease

Question 9

25yo male presents with a headache that he describes as bilateral and band-like in nature. It is made worse by stress

Answer 9

Tension headache

Question 10

35yo female presents with severe unilateral headache with associated phonophobia and photophobia. She describes a visual aura prior to this headache. She has had headaches like this before, typically occurring around the start of her menstrual cycle

Answer 10

Migraine

Question 11

A 35yo patient develops acute onset drooping of the face on one side, and involving the forehead. There are no other neurological symptoms. Over the next 4-6 months, the symptoms subside without treatment

Answer 11

Bell’s palsy

Other causes of facial palsy: stroke/TIA, tumour/mass, meningitis, herpes zoster oticus, HIV, basal skull fracture, parotid gland tumours or surgery, acute otitis media

Question 12

A patient a high altitude presents with drowsiness and ataxia. On examination, papilloedema is noted

Answer 12

Cerebral oedema (high altitude)

Question 13

A patient presents with worsening headache, nausea and vomiting and drowsiness. CT brain reveals dilated ventricles due to an obstruction in the ventricular system

Answer 13

Hydrocephalus

Question 14

An 85yo male presents with his daughter. His daughter notes that he has had recent trouble remembering names and is getting lost in normally familiar places. He is treated with donezepil

Answer 14

Alzheimer’s disease

Question 15

A 74yo male presents with his son. His son notes recent degeneration in his father’s cognition following a recent stroke. On examination, frontal release reflexes are present His past history includes multiple strokes, hypertension and ischaemic heart disease.

Answer 15

Multi-infarct dementia

Question 16

A 75yo male presents with difficulty sleeping due to excessive leg movements at night. This is relieved with activity

Answer 16

Restless legs syndrome

Question 17

A 25yo female presents with presents with 3 weeks of leg weakness. The weakness eventually subsides. Two months later she returns complaining of extreme fatigue and a tingling sensation in her right arm. An MRI is performed

Answer 17

MS

Question 18

Patient presents following an episode of loss of consciousness. Her daughter described an episode where her mother cried out before jerking for about 2 minutes. She went blue and bit her tongue. She was confused following this event

Answer 18

Generalised tonic-clonic seizure

Question 19

A 6yo boy presents following repeated episodes where he is was unresponsive for about 6-7 seconds. He could not remember having these episodes

Answer 19

Childhood absence epilepsy

Question 20

A 16yo boy presents following numerous generalised tonic clonic seizures. He describes a new phenomenon where he feels like he is in a “vague cloud”

Answer 20

Juvenile absence epilepsy

Question 21

A 17yo girl presents with episodes of loss of consciousness where she has involuntary muscle twitches. She also has had generalised tonic-clonic seizures in the past

Answer 21

Juvenile myoclonic epilepsy