Neurology Flashcards
A 50-year-old man presented to his GP with a 5-month history of increasing weakness of his right side (arm and legs). Over the past 3 months, he has been complaining of headaches, which are gradually getting more severe. Over the last 5 years, he has had a number of blackouts with incontinence.
O/E: weakness of right upper and lower limbs and papilloedema.
Which of the following would best explain his clinical picture?
A ) Cerebral abscess
B ) Left frontal meningioma
C ) Left sided cerebral haemorrhage
D ) Right frontal glioblastoma multiforme
E ) Sagittal sinus thrombosis
B ) Left frontal meningioma
A 43-year old woman presents to the ED after her husband noticed that her right lower eyelid seemed to lag last night and has a painful right ear. By the time they see you the following day, the corners of her mouth appear to droop a little on the right and she is experiencing mild dysarthria. She has come into the hospital fearing a stroke.
You also note small vesicles in the right external meatus. What does this patient likely have?
A ) Bell’s Palsy
B ) Lyme disease
C ) Parotid gland neoplasm
D ) Ramsey-Hunt syndrome
E ) Transient ischaemic attack
D ) Ramsey-Hunt syndrome
Answer: False, True, True, True, False
Bilateral recurrent nerve paralysis occurs in less than 0.1% of patients following thyroidectomy. This causes adduction of the vocal cords during inspiration, leading to obstruction of the airway and aphonia. It is a rare complication of total thyroidectomy that requires emergency airway management.
Occlusion of which dominant-hemisphere vessel can result in alexia without agraphia?
A ) ACA
B ) ICA
C ) MCA
D ) PCA
E ) PICA
D ) PCA
Occlusion of which vessel can lead to sensory loss of the ipsilateral face and contralateral arm?
A ) ACA
B ) ICA
C ) MCA
D ) PCA
E ) PICA
** E ) PICA**
This is known as lateral medullary syndrome (Wallenberg’s syndrome).
A 31-year-old man complains of daily headaches for the last two weeks. He has approximately eight episodes per day, each lasting 20 min. The headaches are described as ‘throbbing’, and localised to the left periorbital area. They are accompanied by tearing of the left eye, left ptosis, rhinorrhea, and facial redness. The patient remembers having a similar problem two years ago that lasted for three weeks. He did not seek medical help at that time. The patient feels that the headaches are often precipitated by drinking a glass of wine.
Which of the following is the most likely diagnosis?
A ) Trigeminal neuralgia
B ) Cluster headache
C ) Migraine headache
D ) Sinusitis
E ) Tension headache
B ) Cluster headache
Answer: Myasthenia gravis
Answer: Right lateral medullary stroke
A neurological examination of a 75-year-old male reveals that when the abdominal wall is stroked, the muscles of the abdominal wall of the side of the body stimulated failed to contract. Other neurological tests appeared normal. The likely region affected includes
A ) C1–C5 spinal segments
B ) C6–T1 spinal segments
C ) L1–L5 spinal segments
D ) T2–T7 spinal segments
E ) T8–T12 spinal segments
E) T8–T12 spinal segments
Explanation: In this case, there is a loss of superficial abdominal reflexes, which require that spinal segments T8–T12 are intact. The test for these reflexes is to stroke a quadrant of the abdominal wall with an object such as a wooden stick. The normal response is for the muscle of the quadrant stimulated to contract and for movement of the umbilicus in the direction of the stimulus.
A 20-year-old motorcyclist was rushed into ED. He has been involved in a traffic accident and was found alone on the road.
O/E: He appears drowsy and is making some grunting sounds, pupils are equal and reactive to light, eyes open to pain and he withdraws his hand while the nurses try to insert a cannula.
What is his Glasgow Coma Scale (GCS) score?
A ) 10
B ) 4
C ) 5
D ) 8
E ) 9
Answer: 8
Eye – open to pain = 2
Verbal – inappropriate sounds – 2
Motor – withdraws from pain – 4
A 22-year-old woman presents with diplopia for several weeks. She admits to occasional vertigo and ataxia. Six months ago, she had urinary incontinence for 1 month. Examination of the eyes reveals a gaze-evoked nystagmus, and fundoscopic exam reveals swelling of the optic nerve (papillitis). The patient has increased muscle tone of the lower extremities and is hyperreflexic. She has bilateral extensor plantar reflexes and loss of position sense up to the ankle.
Which of the following is the most likely diagnosis?
A ) Acute transverse myelitis
B ) Brown-Séquard syndrome
C ) Friedreich’s ataxia
D ) Multiple sclerosis
E ) Syringomyelia
D ) Multiple sclerosis
_____ is an autosomal recessive disease in which young patients present with pes cavus foot deformity, spasticity, areflexia, ataxia, and cardiomyopathy.
A ) Acute transverse myelitis
B ) Brown-Séquard syndrome
C ) Friedreich’s ataxia
D ) Multiple sclerosis
E ) Syringomyelia
Friedreich’s ataxia
____ is characterised by contralateral loss of pain and temperature and ipsilateral spasticity, weakness, hyperreflexia, extensor plantar reflex, and loss of proprioception (vibration and position sense).
A ) Acute transverse myelitis
B ) Brown-Séquard syndrome
C ) Friedreich’s ataxia
D ) Multiple sclerosis
E ) Syringomyelia
Answer: Brown-Séquard syndrome
Answer: Amyotrophic lateral sclerosis
Answer: Internuclear ophthalmoplegia
Answer: Cervical myelopathy
Answer: Right lenticulostriate branches of the middle cerebral artery
Answer: ESR
Answer: Sparing of sensation; ocular muscles; and bowel, bladder, and sphincter function
Answer: Small cell carcinoma
Answer: Thymoma
If immediate improvement is essential for survival, which of the following options is the fastest way to manage myasthenia gravis?
A ) Antivirals
B ) Glucocorticoids
C ) High dose cyclophosphamide
D ) IVIg
E ) Thymectomy
D ) IVIg
Answer: The deep tendon reflexes are normal
Explanation: The options below are helpful in distinguishing between Lambert Eaton syndrome, botulism, and myasthenia gravis. The reflexes of a person with Lambert-Eaton syndrome and botulism are diminished or absent, however, in a person with myasthenia gravis, the DTR’s are normal.
Which of the following pathologies causes a combination of ipsilateral spastic paresis below the lesion, ipsilateral loss of proprioception and vibration sensation, and contralateral loss of pain and temperature sensation?
A ) Anterior spinal artery occlusion
B ) Brown-Sequard Syndrome
C ) Friedrich’s ataxia
D ) Neurosyphilis
E ) Subacute combined degeneration of the spinal cord
Answer: Brown-Sequard Syndrome
