Neurology and Stroke

Question 1

You meet a 73-year-old lady who gives a history of progressive difficulty swallowing. Her speech has also become less distinct. She can feel breathless at times, particularly when lying down and her right hand feels weak. Her daughter is becoming worried about her mood as she’s noticed that television programmes and films are making her cry, which is very unusual for her. Based on his history, what might you expect to find on examination?

A - fasciculation and brisk reflexes
B - sensory changes in the C2 distribution
C - proximal muscle weakness
D - weakness of shoulder adduction more than abduction
E - ptosis and ophthalmoplegia

Answer 1

A - fasciculation and brisk reflexes

Question 2

Please see this 35-year-old lady who presents with painful loss of vision, now resolving. Of note she had an episode of weakness of her right leg last year, which resolved. I am concerned about XXXX condition.

You meet with the patient and take a history. She describes an aching pain behind the eye with associated blurring of part of her vision and loss of colour in the affected area. This began approximately two months ago, built up over a week and is now improving. There is / has been no headache. From the description of visual symptoms, what are you most likely to find on examination?

A - Altitudinal visual defect on the affected side
B - Impaired visual acuity, improved with pin hole
C - Pale optic disc on affected side
D - Papilloedema
E - Relative afferent pupillary defect on the unaffected side

Answer 2

C - Pale optic disc on affected side

Question 3

Which of the following drugs would be an absolute contra-indication to thrombolysis?

A - Ticagrelor
B - Bisoprolol
C - Clopidogrel
D - Aspirin
E - Edoxaban

Answer 3

E - Edoxaban (anticoagulant)

Question 4

A 44-year-old woman is reviewed at the TIA outpatient clinic. She describes 10-minute episode 2 days previously where she felt that her left hand had ‘pins and needles’. Afterwards family thought her speech was slurred for another few minutes. She reports having a headache later in the day on the right side of her head. She has no past medical history and is not on any medication.

Which of the following is the most likely diagnosis?

A - Migraine
B - Hypoglycaemia
C - Brain tumour
D - TIA
E - Seizure

Answer 4

A - Migraine

Question 5

Which of the following would be a contra-indication to thrombolysis?
A - Previous ischaemic stroke
B - Onset more than 3 hours ago
C - Clopidogrel therapy
D - Age over 80
E - Previous subdural haematoma

Answer 5

E - Previous subdural haematoma

Question 6

Which type of haematoma crosses suture lines?

Answer 6

Subdural haematoma

Question 7

Which artery is commonly ruptured in extradural haematomas?

Answer 7

Middle meningeal artery as extradural haematomas commonly occur in the temporal region

Question 8

Which head injury can result in a lucid interval?

Answer 8

Extradural haematoma

Question 9

What are the risk factors for a subdural haematoma?

Answer 9

Old age
Alcoholism
Anticoagulation

Question 10

Which head injury can result in fluctuating confusion/consciousness?

Answer 10

Subdural haematoma

Question 11

What is the classic sigh of a subarachnoid haemorrhage?

Answer 11

Sudden occipital headache