Neurology - Collapse : What is the Cause ?

Question 1

differential diagnoses for collapse

Answer 1

epilepsy
syncope
psychogenic attacks
TIA
migraine
hypoglycaemia
infection

Question 2

what is important to consider when taking a collapse history

Answer 2

witnesses

before, during , after event

Question 3

examinations for collapse

Answer 3

cardiovascular
hr and bp
precordium
neuro

Question 4

investigation for blackouts

Answer 4

ecg
carotid sinus massage
tilt table
echo
mri head
eeg

Question 5

what does inverted t wave indicate

a.atrial fibrillation
b.bundle branch block
c.ventricular tachycardia
d.ventricular hypertrophy

Answer 5

b.bundle branch block

Question 6

what egg changes indicate a trifascicular block

Answer 6

pr prolongation
axis deviation
slurred S wave

Question 7

what parts of the heart are blocked in trifascicular block

a.right bundle branch, left anterior /posterior fascicular block and av block (prolonged pr)

b.left bundle branch, left anterior/posterior fascicular block and av block (prolonged pr)

Answer 7

a.right bundle branch, left anterior /posterior fascicular block and av block (prolonged pr)

Question 8

what ecg changes occur in right bundle branch block

Answer 8

qrs more than 120 ms
broad S wave in v5/v6
large r wave in v1/v2

Question 9

ecg criteria for left anterior fascicular block

Answer 9

left axis deviation (L1> L3)

Question 10

which type of syncope shows trifascicular block

a.cardiac
b.vasovagal
c.carotid sinus
d.orthostatic hypotension
e.psychogenic attacks

Answer 10

a.cardiac

Question 11

patient fainting , experiences nausea preceeding and a gradual build up, witness says they looked pale and did not jerk, they have no incontinence and it lasted 20 seconds the patient felt tired for a few hrs after what is more likely

a.vasovagal
b.cardiac

Answer 11

a.vasovagal

Question 12

patient had fainted suddenly, witness said they looked and had no jerks / incontinence, patient said they bit their tongue a bit and it lasted a few mins, afterwards they experienced no confusion or fatigue

which is more likely

a.vasovagal
b.cardiac

Answer 12

b.cardiac

Question 13

a period of inability to perform voluntary movements at sleep onset or upon wakening during the night or the morning with associated hallucination , sensed presence , pressure of chest and out of body experience

Answer 13

sleep paralysis

Question 14

excess sleepiness typically associated with sleep paralysis and cataplexy

Answer 14

narcolepsy

Question 15

which type of narcolepsy is caused by hypocretin deficiency and is almost always associated with cataplexy

a.type 2
b. type 1
c.idiopathic

Answer 15

b. type 1

Question 16

which type of narcolepsy has 2 or more sleep onset REM periods in multiple sleep latency test

a.type 2
b. type 1
c.idiopathic hypersonic

Answer 16

a.type 2

Question 17

which type of narcolepsy has less than 2 sleep onset REM periods in multiple sleep latency test

a.type 2
b. type 1
c.idiopathic hypersomnia

Answer 17

c.idiopathic hypersomnia

Question 18

in which age group is knlein levin syndrome most common

a.elderly
b.children
c.teenagers

Answer 18

c.teenagers

Question 19

what condition is characterised by persistent episodic hypersomnia , mood changes, hyperphagia (excessive eating) and hyper sexuality . it has recurrent episodes for more than 10 yrs with episodes lasting up to 4 wks . onset of this condition usually follows a viral infection

a.type 1 narcolepsy
b.type 2 narcolepsy
c.vasovagal syncope
d.klein levin syndrome
e. eaton Lambert syndrome
f.idopathic hypersomnia

Answer 19

d.kllein levin syndrome

Question 20

60 yr old obese male patient has excessive day time drowsiness, wakes up with a dry throat , poor memory and concentration, headaches in the morning, nocturna

pmh : hypertension , stroke

what is most likely diagnosis

a.type 1 narcolepsy
b.type 2 narcolepsy
c.vasovagal syncope
d.klein levin syndrome
e. eaton Lambert syndrome
f.idopathic hypersomnia
g.obstructive sleep apnoea

Answer 20

g.obstructive sleep apnoea

Question 21

patient experiencing seizures especially following periods of stress

they are gradual onset, and accompanied by head shaking side to side and back arching , and tongue biting , her limbs also move out of sync , her eyes are closed and she experiences incontinence

what is most likely cause of seizure

a.psychogenic non epileptic
b.epileptic
c.frontal lobe

Answer 21

a.psychogenic non epileptic

Question 22

patient experiencing seizures with tongue biting , cyanosis ,
ictal grasping , noisy breathing and incontinence lasting less than 2 mins and eyes open during onset

what is most likely cause of seizure

a.psychogenic non epileptic
b.epileptic
c.frontal lobe

Answer 22

c.frontal lobe

Question 23

frontal lobe epilepsy mimics what

a.psychogenic seizure
b.narcolepsy
c.idiopathic hypersomnia
d.klein levine syndrome
e.obstructive sleep apnoea

Answer 23

a.psychogenic seizure

Question 24

patient has seizures, eyelids not fully closed, ictal grasping , pelvic thrusting and vocalisation common , happens when they arise from sleep involve quick tonic posturing

which most likely

a.psychogenic non epileptic
b.epileptic
c.frontal lobe

Answer 24

c.frontal lobe

Question 25

what is the gold standard for differentiating seizures

a.mri
b.eeg
c. fmri
d.ecg

Answer 25

b.eeg