Neurology: Past Paper Questions Flashcards
A 50-year-old woman presents to the emergency department with a 3-hour history of severe headache. She has taken paracetamol which has had no improvement to her symptoms. There are associated symptoms of photophobia, neck stiffness, and nausea.
Her medical history includes hypertension and polycystic kidney disease. She has a 25-year smoking pack history and drinks 2 standard drinks a night.
What would be the best initial investigation?
CRP
Contrast CT head
Lumbar puncture
MRI brain
Non-contrast CT head
Non- contrast CT head
SAH can present with signs of meningeal irritation
…… …… ……. is the gold standard for detecting intracranial haemorrhage.
Non-contrast CT
A 26-year-old male is struck on the side of the head above the ear by a fast moving golf ball. He lost consciousness for a few seconds, initially recovered, but then progressively lost consciousness again. He is taken immediately to the emergency department and a CT head revealed a right-sided extradural haematoma. He is noted to have a right-sided dilated and unreactive pupil.
What cranial nerve is being compressed in order to explain his pupillary abnormality?
2
3
4
5
6
3- oculomotor (efferent part of pupil reflex)
Uncal herniation causes a dilated pupil due to compression of the third cranial nerve
…….. causes a dilated pupil due to compression of the third cranial nerve
Uncal herniation
when to CT after head injury
CT head within 1 hour
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
post-traumatic seizure.
focal neurological deficit.
more than 1 episode of vomiting
after a subarachnoid ahemorrhage what may be found in the lumbar puncture
xanthochromia
yellow discoloration indicating the presence of bilirubin in CSF which appears as oxyhaemoglobin released from the breakdown of red blood cells following haemorrhage into the CSF is converted in vivo into bilirubin in a time-dependent manner.
A 57-year-old female attends the emergency department with a sudden onset of a severe occipital headache and two episodes of vomiting in the past hour. An urgent CT scan finds no abnormalities, however, a lumbar puncture taken 12 hours later is positive for xanthochromia, and subarachnoid haemorrhage (SAH) is diagnosed. Urgent neurosurgical review is requested and a CT cerebral angiography indicates a posterior communicating artery aneurysm as the cause of the SAH. The patient is otherwise fit and well.
Which option is most likely to be the optimal treatment for the aneurysm?
Insertion of an extraventricular drain
Extracranial-intracranial bypass
Coiling by an interventional neuroradiologist
Nimodipine only
Surgical clipping
Coiling by an interventional neuroradiologist
You are called to see a 33-year-old male on the ward who is recovering following a subarachnoid haemorrhage (SAH) he had three days ago. Today, he has become more drowsy and nauseous and is complaining of a new headache and muscle cramps. Physical examination is normal.
What is the most likely diagnosis?
Adrenal crisis
Cerebral herniation
Encephalitis
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Vasospasm
SIADH is a common consequence of subarachnoid haemorrhage
You are covering the neurosurgical unit over night. One of your patients is a man in his seventies, who presented with an intracerebral bleed. CT scan showed there was some extension of the bleed into the ventricles. The patient has remained stable during the day, but one of the nurses bleeps you to inform you that the patient’s Glasgow Coma Scale score has dropped. It was previously 15, but now he only localising to pain. What is the most likely cause of his symptoms?
Expansion of the haematoma
Hyponatraemia
Hydrocephalus
Vasospasm
Hypoglycaemia
Hydrocephalus is a common complication from intraventricular haemorrhages
A 37-year-old woman in her second pregnancy has delivered a live male infant. She has no past medical history of note. Ten minutes after delivery, she complains of a sudden onset severe occipital headache that is associated with vomiting. On examination there is evidence of photophobia. Shortly after this she losses consciousness and has a Glasgow coma score of 8. A CT scan shows blood in the sulci, fissures, basal cisterns. What is the most likely diagnosis?
Extra-dural haematoma
Sheehan’s syndrome
Sub-dural haematoma
Subarachnoid haemorrhage
Intracerebral haemorrhage
x
A subarachnoid haemorrhage (SAH) is a type of stroke which is usually the result of bleeding from a berry aneurysm in the Circle of Willis. Key clinical features include a sudden onset headache which reaches maximum severity in seconds to minutes (‘thunderclap headache’) and meningitic symptoms (for example photophobia and neck stiffness).
A 17-year-old male presents to the emergency department (ED) following a head injury during a rugby match.
His parents who witnessed the injury tell you he lost consciousness immediately after the collision for a number of minutes. He was then alert and himself for a couple of hours. They have now bought him to ED as he became drowsy and was complaining of a headache.
On examination his Glasgow coma scale (GCS) is 12, the pupils are unequal and there is a clear swelling on the right side of the head.
Given the likely diagnosis of an intracranial haemorrhage, which vessel has most likely been damaged?
Bridging veins
Carotid artery
Circle of Willis
Dural artery
Middle meningeal artery
Middle meningeal artery
Extradural or subdural haemorrhage?
Extradural = lucid period, usually following major head injury. Subdural = fluctuating consciousness, often following trivial injury in the elderly or alcoholics
A 55-year-old man presents to his GP with visual disturbance.
On examination, the patient is noted to have visual field abnormalities; he is unable to perceive stimuli in the superior temporal field of his left eye and the superior nasal field of his right eye.
The GP requests an MRI urgently.
Where is a lesion most likely to be found?
Left parietal lobe
Left temporal lobe
Optic chiasm
Right parietal lobe
Right temporal lobe
Right temporal lobe
Superior homonymous quadrantanopias are caused by lesions of the inferior optic radiations in the temporal lobe
A 27-year-old man attends his GP with increasing ascending weakness in his legs. He is otherwise well, although he had an episode of diarrhoea and vomiting from a barbecue outing with his friends 3 weeks ago. He does not have any other medical conditions.
On examination, there are reduced ankle reflexes and mild distal paraesthesia of his legs.
What symptom is commonly seen in patients with the likely diagnosis?
Back pain
Diarrhoea
Diplopia
Fasciculations
Papilloedema
Back/leg pain is seen in the majority of patients with Guillain-Barre syndrome
Important for meLess important
Back pain is the correct answer. The patient’s recent history of gastroenteritis followed by peripheral nerve symptoms suggests Guillain-Barre syndrome, an immune-mediated peripheral neuropathy that often occurs 1-3 weeks post-infection. Pain, particularly in the back and legs, is a common early feature due to nerve root inflammation and may precede motor symptoms such as weakness. This pain, described as deep, aching or cramping, serves as an important early clinical clue in diagnosing Guillain-Barre syndrome, especially when coupled with a history of recent infection and symptoms of ascending weakness.
first symptom of GBS usually
back pain
