Neurology

Question 1

Where is the likely lesion in a patient with progressive imbalance, difficulty with coordination, positive Romberg’s test, slurred speech, slow and irregular rapid alternating movements?

Answer 1

cerebellum

Question 2

What is the most appropriate next step for a patient who has progressive memory decline, difficulty with activities of daily living, and a MoCA score indicating mild cognitive impairment?

Answer 2

MRI

Question 3

What is the likely affected CNS region in a patient with weakness in the left elbow extension, left wrist flexion, left finger extension, and reduced sensation over the left index finger, middle finger, and medial half of the ring finger?

Answer 3

C7 nerve root

Question 4

What is the appropriate treatment for a patient with classical features of alcohol withdrawal ?

Answer 4

GABA receptor agonists / benzodiazepine

Question 5

What are the symptoms of carpal tunnel syndrome?

Answer 5

paresthesia in the thumb, index, middle, and lateral aspect of the ring fingers, as well as waking up at night
symptoms brought on by holding things

Question 6

Where is the location of site of lesion in the following situations?
- left internuclear ophthalmoplegia
- left sided facial weakness
- right sided limb ataxia
- diminished sensation to pinprick on right side of face
- diminished sensation to pinprick on left side of body

Answer 6

• left internuclear ophthalmoplegia = medial longitudinal fascicles in the pons
• left sided facial weakness = facial nerve nucleus or emerging fibres in the pons
• right sided limb ataxia = ipsilateral cerebellar pathways
• diminished sensation to pinprick on right side of face = ipsilateral spinal trigeminal nucleus
• diminished sensation to pinprick on left side of body = contralateral spinothalamic tract

Question 7

What is the most likely diagnosis when there are a combination of ipsilateral cranial nerve deficits and contralateral long tract signs?

Answer 7

Wallenberg’s syndrome - type of brainstem stroke (lateral medullary syndrome)

Question 8

What neurotransmitter is depleted in Parkinson’s?

Answer 8

dopamine

Question 9

What neurological condition presents with increased rigidity in all four libs and a history of falls?

Answer 9

Parkinson’s

Question 10

What pathology characterised Parkinson’s?

Answer 10

degeneration of dopaminergic neurones in the substantia migration resulting in a decrease in dopamine levels in the brain

Question 11

What is the function of dopamine in the brain? And what does its deficiency lead to?

Answer 11

plays a crucial role in regulating movement and coordination, and its deficiency leads to motor symptoms such as tremors, rigidity, and impaired balance

Question 12

What is the most likely diagnosis in a patient with tongue fasciculations, weakness of foot and ankle dorsiflexion, and reduced grip strength as well as difficulty swallowing and choking on food?

Answer 12

motor neurone disease

Question 13

What nerve is affected in acute acquired third nerve palsy? And describe the symptom.

Answer 13

left oculomotor nerve
sudden onset of binocular horizontal, vertical or oblique and droopy eyelid
eye rests in down and out position

Question 14

What can third nerve palsy be a complication of?

Answer 14

third nerve palsy