Neurology Flashcards
Motor neurone disease
A 66-year-old woman complains of stiffness and weakness climbing stairs. She has
a history of hypertension and diet-controlled type 2 diabetes. On examination,
there is mild upper arm weakness, hip flexion is 4−/5 bilaterally, with bilateral
wasting and flickers of fasciculations in the right quadriceps. Knee extension is 4/5.
Dorsiflexion and plantar flexion are strong. Brisk knee and ankle reflexes are
elicited, as well as a positive Hoffman’s and Babinski’s sign. Sensory examination
and cranial nerves are normal. Her BM is 8.9, her pulse is regular and her blood
pressure is 178/97. What is the most likely diagnosis?
A. Myasthenia gravis
B. Diabetic neuropathy
C. Myositis
D. Motor neurone disease
E. Multiple sclerosis (MS)
Lesion localization (1)
A 23-year-old man is stabbed in the neck. Once stabilized, his MRI shows a right
hemisection of the cord at C6. What is the expected result of this injury?
A. Paralysed diaphragm
B. Absent sensation to temperature in the left hand
C. Paralysis of the left hand
D. Absent sensation to light touch in the left hand
E. Brisk right biceps reflex
Multiple sclerosis treatment
A 23-year-old woman complains that her right leg has become progressively stiff
and clumsy over the last couple of weeks. She is worried as she has not been able
to go to work for the last 4 days. On examination, tone is increased and there is a
catch at the knee. She has six beats of clonus and an upgoing plantar. Power is
reduced to 3-4/5 in the right leg flexors. There is no sensory involvement and the
rest of the neurological exam is normal other than a pale disc on opthalmoscopy.
On further questioning, she admits that she has had two episodes of blurred vision
in her right eye in the last two years. Each lasted a couple of weeks from which she
fully recovered. What is the most appropriate initial treatment?
A. A non-steroidal anti-inflammatory drug (NSAID)
B. Interferon-beta
C. Bed rest
D. Methotrexate
E. A course of oral steroids
Lesion localization (2)
A 78 year old right-handed male collapses and is brought into accident and
emergency. He seems to follow clear one-step commands but he gets very frustrated
as he cannot answer questions. He is unable to lift his right hand or leg. He has an
irregularly irregular pulse and his blood pressure is 149/87. He takes only aspirin
and frusemide. What is the most likely diagnosis?
A. Left cortical infarct
B. Right internal capsule infarct
C. Left cortical haemorrhage
D. Left internal capsule haemorrhage
E. Brainstem haemorrhage
Glasgow Coma Scale
A 19-year-old woman collapses at a concert and is witnessed to have a tonic-clonic
seizure lasting 2 minutes. When the paramedics arrive and ask her questions, she
mumbles but no-one can understand what she is saying. Only when the paramedic
applies pressure to her nailbed does she open her eyes and reach out with her other
hand to rub her nail and then push him away. What is her Glasgow Coma Scale
(GCS)?
A. 12
B. 11
C. 10
D. 9
E. 8
Risk factors in stroke
A 79-year-old man is admitted with left hemiparesis. CT reveals a middle cerebral
artery infarct. What is his most significant risk factor for stroke?
A. Hypertension
B. Smoking
C. Family history
D. Diabetes
E. Cholesterol
Multiple sclerosis prognosis
A 42-year-old woman presents with ataxia. Gadolinium-enhanced MRI reveals
multiple subcortical white matter lesions as well as enhancing lesions in the
cerrebellum and spinal cord. She is diagnosed with MS. Two months later she
develops optic neuritis. What feature is associated with a milder disease course?
A. Her age of 42
B. Her initial presentation of ataxia
C. Her female gender
D. The interval between the two episodes of two months
E. Her MRI scan appearance
Seizure (1)
A 71-year-old man with atrial fibrillation is seen in clinic following an episode of
syncope. He describes getting a poor night’s sleep and, as he got out of bed in the
morning, feeling dizzy for a couple of seconds before the lights dimmed around
him. He was woken a couple of seconds later by his wife who had witnessed the
event. She says he went pale and fell to the floor and his arms and legs jerked. After
waking, he was shaken but was ‘back to normal’ a few minutes after the event. His
medication includes aspirin, atenolol and frusemide. What is the most likely
diagnosis?
A. Vasovagal syncope
B. Orthostatic hypotension
C. Cardiogenic syncope
D. Transient ischaemic attack (TIA)
E. Seizure
Headache (1)
A 41-year-old man complains of terrible headache. It started an hour ago, without
warning, while stressed at work. It affects the right side of his head. He scores it
‘11/10’ in severity. When asked, he agrees that light does bother him a little. He had
a similar episode six months ago, experiencing very similar headaches over 2 weeks
which resolved spontaneously. On observation, he looks quite distressed and prefers
to pace up and down, unable to sit still. What is the diagnosis?
A. Subarachnoid haemorrhage
B. Tension headache
C. Intracerebral haemorrhage
D. Migraine
E. Cluster headache
Visual loss
A 49-year-old man complains of sudden onset, painless unilateral visual loss
lasting about a minute. He describes ‘a black curtain coming down’. His blood
pressure is 158/90, heart rate 73 bpm. There is an audible bruit on auscultation of
his neck. His past medical history is insignificant other than deep vein thrombosis
of his right leg ten years ago. The most likely diagnosis is:
A. Retinal vein thrombosis
B. Retinal artery occlusion
C. Amaurosis fugax
D. Optic neuritis
E. Acute angle glaucoma
Stroke treatment
A 77-year-old woman is admitted to hospital with a urinary tract infection. She
receives antibiotics and seems to be responding well. On the fourth day she is
eating her lunch when she suddenly drops her fork. She calls for the nurse who
notices the left side of her face is drooping. What is the best next course of action?
A. CT head
B. Thrombolysis
C. MRI head
D. Aspirin
E. Place nil by mouth
Contraindications for thrombolysis
A 71-year-old right-handed male is brought in by ambulance at 17:50 having
suffered a collapse. His wife came home to find him on the floor unable to move
his right arm or leg and unable to speak. Her call to the ambulance was logged at
17:30. He has a past medical history of well-controlled hypertension, ischaemic
heart disease and atrial fibrillation for which he is on warfarin. He had a hernia
repair three months ago and his brother had a ‘bleed in the brain’ at the age of 67.
What is the absolute contraindication to thrombolysis in this male?
A. Family history of haemorrhagic stroke
B. History of recent surgery
C. Time of onset
D. Current haemorrhagic stroke
E. Warfarin treatment
Guillain–Barré syndrome
A 69-year-old man presents to clinic with a six-month history of progressive lower
back pain which radiates down to his buttock. He found the pain was exacerbated
while taking his daily morning walk and noticed that it eased going uphill but
worsened downhill. He stopped his daily walks as a result and he now walks only
slowly to the shops when he needs to, taking breaks to sit down and ease the pain.
He has a history of hypertension, diabetes and prostatic hyperplasia. What is the
diagnosis?
A. Peripheral vascular disease
B. Osteoporotic fracture
C. Spinal stenosis
D. Sciatica
E. Metastatic bone disease
Spinal claudication
A 31-year-old woman presents to accident and emergency with progressive
difficulty walking associated with lower back pain. A few days ago she was tripping
over things, now she has difficulty climbing stairs. She describes tingling and
numbness in both hands which moved up to her elbows, she is unable to write. On
examination, cranial nerves are intact but there is absent sensation to vibration and
pin prick in her upper limbs to the elbow and lower limbs to the hip. Power is 3/5
in the ankles and 4−/5 at the hip with absent reflexes and mute plantars. Her blood
pressure is 124/85, pulse 68 and sats 98 per cent on air. She has a past medical
history of type I diabetes and recently recovered from an episode of food poisoning
a month or two ago. What is the diagnosis?
A. MS
B. Guillain–Barré syndrome (GBS)
C. Myasthenia gravis
D. Diabetic neuropathy
E. Infective neuropathy
Parkinson’s associated symptoms
A left-handed 79-year-old man presents with a troublesome resting tremor of his
left hand. The tremor is evident in his writing. He has also noticed his writing is
smaller than it used to be. He complains he has difficulty turning in bed to get
comfortable and his wife complains that he sometimes kicks her in the middle of
the night. When he gets out of bed in the morning he feels a little woozy, but this
resolves after a while. On examination, he blinks about three times a minute and
his face does not show much emotion. Glabelar tap is positive. He has a slow,
shuffling gait. He has difficulty stopping, starting and turning. He holds his feet
slightly apart to steady himself. When you pull him backwards, he is unable to right
himself and stumbles back. Which of the signs and symptoms is not commonly
associated with parkinsonism?
A. Postural instability
B. Rapid eye movement (REM) sleep disturbance
C. Hypomimia
D. Broad-based gait
E. Autonomic instability
Migraine treatment
A 33-year-old woman attends her six-month follow-up appointment for headache.
They are migrainous in nature but whereas she used to have them every few
months, over the last three months she has experienced a chronic daily headache
which varies in location and can be anywhere from 3–7/10 severity. Her last
migraine with aura was two months ago. She takes co-codamol qds and ibuprofen
tds. What is the best medical management?
A. Stop all medication
B. Start paracetamol
C. Start sumatriptan
D. Start propranolol
E. Continue current medication