Neurology RACP MCQs Flashcards
RACP 2022a Q1
1. Which AED needs to be weaned slowly to avoid withdrawal complications?
a. Barbiturate
b. Benzodiazepine
c. Gapapentinoid
d. Sodium valproate
Answer: B
RACP 2022a 16.
75F with unilateral headache, photophobia, N+V with reddened left eye. What is the most appropriate initial investigation?
a. CT Brain
b. CT cerebral angiogram
c. Intraocular pressure measurement
d. Lumbar puncture
ANSWER: C
acute red painful eye ? glaucoma
IOP easy bedside test to rule out glaucoma
RACP 2022 Q29
What would be the expected sign associated with an acute stroke affecting the left frontal eye field
a. Forced deviation to left
b. Skew deviation
c. Right inferior homonymous quadrantanopia
d. Left internuclear ophthalmoplegia
ANS: B
Frontal eye field = area of the brain (anterior to motor cortex)
eyes look toward the side of the lesion
RACP 2022a 39.
A patient presents with undifferentiated seizure syndrome. There are a number of features associated with psychogenic seizure disorder Which is the most sensitive
a. Ictal forced eye closure
b. Ictal pelvic thrusting
c. Icteral stuttering
d. Teddy bear in patient’s bed
Answer: A
Prolactin can be useful in differentiating a pseudoseizure from a true seizure.
https://journals.lww.com/ebp/abstract/2014/11000/how_do_you_differentiate_pseudoseizures_from_real.1.aspx
RACP 2022 Q54.
What improves survival for patients with amyotrophic lateral sclerosis?
a. Care in multidisciplinary clinic
b. NIV
c. Rapid access to riluzole
Answer: C
The question is asking about survival
MDT ~ 6 months increase in survival compared to riluzole ~ 9 months (improved life expectancy)
RACP 2022 Q 55.
What increases risk of Stevens-Johnson syndrome in carbamazepine use?
a. HLAB5801
b. HLAB1502
c. CYP3A4 polymorphism
d. CYP2D6 polymorphism
Answer: B
RACP 2022 Q56
Which cancer has the most neurological paraneoplastic symptoms?
a. Ovarian
b. Breast
c. Thymoma
d. Small cell lung cancer
Answer: D
Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular junction disorder which may present as a paraneoplastic phenomenon or a primary autoimmune disorder. More than half of the cases are associated with small cell lung cancer (SCLC). The primary clinical manifestation is muscle weakness.
RACP 2022 Q57
Elderly patient has stroke with NIHSS of 7 on admission, and is being discharged after 3 month admission undergoing rehab. He can walk with walker and toilet independently. Past medical history of an episode of depression. What is the biggest risk factor for post-stroke depression?
a. Past history of depression
b. Discharge destination
c. Length of hospital stay
d. NIHSS
Answer: A
Personal/ FHx of mental illness
Female
Age < 70
Neuroticism
Severity of stroke
Residual deficits
Protective
Social support
RACP 2022 Q58
58.What is the best method to test to detect Huntington’s disease?
a. PCR with fragment length assessment
b. Microarray
c. Sanger sequencing
Answer: A
PCR analysis to detect an expanded triplet repeat mutation in the Huntington gene.
RACP 2022 Q65
A 78 yo male is having hallucinations of children walking past his window outside. What is the most likely condition?
a. Fronto-Temporal Dementia
b. Alzheimer’s Disease
c. Lewy Body Dementia
d. Delirium
Ans: C
Types of FTD
behavioural variant
fluent (speech devoid of meaning)
non-fluent (semantic dementia)
motor subtypes ( Parkinson plus)
RACP 2022 70.
What deficiency causes restless leg syndrome?
a. Iron
b. Magnesium
c. Zinc
d. Copper
Ans: A
RACP 2022 Q73
BPPV nystagmus question - what would you expect to find on Dix Hallpike in BPPV?
a. Horizontal persistent
b. ?
c. Torsional persistent
d. Torsional crescendo decrescendo
Answer: D
https://www.frontiersin.org/articles/10.3389/fneur.2023.1040701/full
RACP 2022 Q76
80 year old man, presents with R sided face, leg and arm weakness. He has mild dysarthria but no receptive or expressive dysphasia. There is no hemianopia or visual neglect. What is the aetiology of his symptoms
a. Cardioembolism from AF
b. ?
c. R carotid artery dissection
d. R carotid artery occlusion
Answer: ? A
RACP 2022 Q80.
76F post left hip replacement, history of type 2 diabetes, hypertension. In rehab post operatively found to have a left foot drop. On examination she had normal power in upper limbs bilaterally, normal hip and knee flexion and extension. On the left she had 5/5 plantarflexion, 2/5 dorsiflexion, inversion
and eversion 3/5. Reflexes were present except for left ankle jerk and she had decreased sensation over the sprain of her left foot. EMG 10 days post operatively demonstrated denervation on tibialis anterior and tibialis posterior, with normal gluteal and paraspinal muscles. Damage to which structure is the
cause of her foot drop?
a. common peroneal
b. L5/S1 radiculopathy
c. lumbosacral plexopathy
d. sciatica
ANSWER: D
RACP 2022B Q8.
What is the visual deficit of a left temporal radiation lesion?
A. left superior hemianopia
B. left inferior hemianopia
C. right inferior hemianopia
D. right superior hemianopia
Ans: D
RACP 2022B Q 33.
What entrains the circadian rhythm of the suprachiasmatic nucleus?
A. Melatonin
B. Cortisol
C. Light dark cycle
D. Food intake
Ans: C
RACP 2022b Q37.
What is antibody associated with Lambert Eaton myasthenic
syndrome?
A. Anti-MuSK
B. Anti-ACh receptors
C. P/Q-type voltage-gated calcium channels
Answer C
Autoantibodies directed against presynaptic voltage-gated calcium channels (anti-VGCC antibodies) → ↓ Ca2+ influx → ↓ presynaptic vesicle fusion → impaired acetylcholine release in the NMJ
RACP 2022 Q39
With natural ageing, you lose working memory, episodic memory and one other cognitive domain. What is the other cognitive domain?
A. Semantic memory
B. Procedural memory
C. Executive function
D. Attention
Answer: A
RACP 2022b 47. Abnormalities of which receptor is implicated in alcohol withdrawal seizures?
A. NMDA
B. GABA
C. Noradrenaline
Answer: B
RACP 2022 55.
What sign occurs on Dix-Hallpike testing in a patient with BPPV affecting left
posterior semicircular canal?
A. Left persistent nystagmus
B. crescendo-decrescendo left nystagmus
C. crescendo-decrescendo torsional vertigo nystagmus
Answer: C
RACP 2022 58.
What type of genetic analysis is used to make a diagnosis of huntingtons?
A) Comparative genomic hybridization
B) Exone sequencing
C) PCR + fragment sizing
D) Sanger sequencing
Answer: C
RACP 2021 Q1.
A 72 year old man presents with unilateral ptosis and meiosis. What is the best initial investigation?
A. MRI B
B. CTB
C. CXR
D. CT Carotid Angiography
Ans D
RACP 2021 Q6.
A 70 year old male with a history of Parkinson’s disease presents with nausea and vomiting. Which of the following medications would most likely cause an exacerbation of the patient’s Parkinson’s disease?
A. Cyclizine
B. Metoclopramide
C. Domperidone
D. Ondanestron
Ans: B
RACP 2021 Q13
Q13. High flow oxygen is useful in the treatment of which of the following headache syndromes?
A. Cluster headache
B. Hypnic headache
C. Migraine
D. Trigeminal neuralgia
Answer: A
RACP 2021 Q22. A 48 year old male presents with 3 day history of fever, lower back pain, urinary incontinence and difficulty walking. He occasionally injects recreational drugs and has history of depression. On examination his temperature is 37.9C, lower midline lumbar tenderness, paravertebral muscle spasms and an otherwise normal neurological
examination.
What is most likely diagnosis?
A. Guillain-Barré syndrome
B. Ankylosing spondylitis
C. Pyelonephritis
D. Spinal abscess
Answer: D
RACP 2021 Q35
Q35. A 24yo male presents with dystonia after being administered haloperidol. What medication should be given
to reverse the dystonia?
A. Diazepam
B. Benztropine
C. Propranolol
D. Phenytoin
Ans: B
RACP 2021 Q41
A 76 year old lady admitted for elective left hip revision with a background of hypertension, T2DM and OA of the spine. On admission to rehab clear she is noted to have a left foot drop. Her upper limbs examine normally. She has normal hip and knee flexion and extension bilaterally. Her left foot dorsiflexion power is 5/5, plantarflexion 2/5, inversion and eversion 3/5. She has a reduced left ankle jerk reflex
with subjective sensory loss at base of foot. EMG testing 10 days after the operation showed denervation of
tibialis anterior and tibialis posterior.
Where is the site of her injury?
A. Common perineal nerve
B. L5 radiculopathy
C. Lumbosacral plexus injury
D. Sciatic nerve injury
Ans: D
RACP 2021 Q45
Q45. A 40 year old woman presents with a long history of somatic symptoms including headache, chest pain, lethargy, abdominal pain and paraesthesias. She is very worried about what her symptoms might mean and is
only briefly reassured after consultation. Repeated investigation has not shown any cause for her symptoms. She continues to present, and describes herself as “sickly” and “never well”.
What is the most likely psychiatric cause of her symptoms?
A. Delusional disorder (somatic type)
B. Factitious disorder
C. Hypochondriasis (illness anxiety disorder)
D. Somatisation disorder (somatic symptom disorder)
Ans: D
RACP 2021 Q59
Q59. A 24 year old male presents with intrusive neurological symptoms and frequent nodding of his head. His symptoms subsequently changed to right arm swinging and sensation of frequent need of swallowing. His mother
also reports symptoms suggestive of OCD.
Which of the following is the likely diagnosis?
A. Huntington disease
B. Wilson disease
C. Tourette syndrome
D. Neuroacanthocytosis
Ans: C
RACP 2021 Q101
Q101. What is the antibody target in Lambert Eaton syndrome?
A. Pre-synaptic voltage gated calcium channel (VGCC)
B. Acetylcholine receptors in the NMJ
C. Muscle-specific tyrosine kinase (MuSk)
D. Low-density lipoprotein receptor-related protein 4 (Lrp4)
Ans: A
remaining options are for MG
ACH most common
MuSK 2nd most common (85% of these are F)
LRP4 ( 20% of double negative MG)
RACP 2021 Q112.
What two cranial nerves are responsible for the corneal reflex?
A. II and III
B. V AND VI
C. V AND VII
D. VI AND VII
Ans: C
RACP 2021 Q113. Spinocerebeller ataxia is a trinucleoside repeat disorder. Which investigation is most likely to show the
pathogenic mutation?
A. CGH
B. FISH
C. PCR
D. Sanger sequencing
Ans: C
RACP 2021 Q119.
Winging of the scapula can be caused by a lesion of which nerve?
A. Axillary nerve.
B. Long thoracic nerve.
C. Interosseous nerve.
D. Scapular nerve.
Ans: B
RACP 2021 Q135. An 84 year old woman with Alzheimer’s disease presents to ED with 1 day of significant restlessness and agitation such that she cannot sit still for even a minute. She is not on any regular medications usually but was
started on haloperidol regularly after an episode of verbal aggression 2 days prior. Her physical examination and investigations are normal. What is the likely diagnosis?
A. Acute psychosis
B. Akathisia
C. Restless legs syndrome
D. Urinary tract infection
Ans: B
https://pmhealthnp.com/how-i-treat-tardive-dyskinesia/
RACP 2021 Q137. A 23 year old female presents with exercise induced muscle cramps. She was found to have CK of 23,000.
She develops muscle cramp after exercise but her symptoms improve after few minutes of rest. She can then exercise for a prolonged period of time at a low intensity. What’s the most likely diagnosis?
A. Becker muscular dystrophy
B. CPT2 deficiency
C. Kennedy disease
D. McArdle disease
Ans: D
BMD - X-linked recessive, life expectancy ~ 40 years, (single ladies picture)
CPT2 deficiency - a long-chain fatty acid oxidation disorder
Kennedy disease - Spinal and Bulbar Muscular Atrophy (SBMA)
McArdles - Glycogen storage disease
FFA deficiency no cross country
Glucose deficiency no sprint
RACP 2021 Q139
Where is the predominant site of cerebrospinal fluid production?
A. Arachnoid
B. Choroid plexus
C. Arachnoid granulations
D. Sylvian aqueduct
Ans: B
RACP 2021 Q149.
What sensory system reaches its cortex via a purely extrathalamic pathway?
A. Olfactory
B. Visual
C. Auditory
D. Sematosensory
Ans: A
RACP 2021Q157.
Which clinical feature developing early in the course of disease is suggestive of frontotemporal dementia
rather than Alzheimer’s dementia?
A. Disinhibition and impulsivity
B. Memory loss
C. Frequent falls
D. Parkinsonism and visual hallucinations
Ans: A
RACP 2021 Q158
Which neurotransmitter activates NMDA receptors?
A. Acetylcholine
B. GABA
C. Glutamate
D. Glycine
Ans: C
RACP 2021 Q159. Progressive multifocal leucoencephalopathy is caused by which of the following viruses?
A. JC virus
B. Adenovirus
C. EBV
D. HSV
Ans: A
RACP 2020 Q2.
Patient with left homonymous hemianopia, ignores the left side of her plate and bumps into
things on her left side. Where is the lesion?
A) Parietal
B) Temporal
C) Occipital
D) Optic radiation
Ans: A
RACP 2020 Q 6
In acute seizures, certain medications are used including diazepam, lorazepam, phenytoin and
phenobarbital. Which of the following cannot be used to control seizures due to lidocaine
(lignocaine) toxicity?
A) Diazepam
B) Oxazepam
C) Phenobarbital
D) Phenytoin
ANS: Dunno -_/-
Oxazepam - benzo
Phenobarbital - chloride channels
Phenytoin - sodium channels
RACP 2020 Q19
19. A 30 yo male has woken up at 3am with sudden drilling pain behind the eye. The pain is so severe it causes him to bang his head against the wall. This has occurred on several occasions and episodes resolve within 30 seconds. The headache is sometimes accompanied by visual change and ptosis. What is the most likely diagnosis?
A) Cluster headaches
B) Hypnic headaches
C) Paroxysmal hemicrania
D) Trigeminal neuralgia
Ans: A
RACP 2020 25. What is the dose of thiamine for Wernicke’s encephalopathy?
A) 100mg oral three times a day
B) 300mg oral three times a day
C) 300mg IV daily
D) 300mg IV three times a day
Ans: D
RACP 2020 Q45
A gentleman has myotonic dystrophy and is symptomatic of heart failure and generalised
weakness/myopathy. His father has mildly reduced grip strength. What is the underlying genetic abnormality which explains this?
A) Maternal imprinting
B) Triplet repeat
C) paternal somatic mutation
D) Mitotic non-disjunction
Ans: B
https://practicalneurology.com/articles/2019-aug-july/noninflammatory-myopathies
RACP 2020 Q47
A table was given with gabapentin euqivalence dosing to pregabalin; gabapentin 300 -
pregabalin 75, gabapentin 600 - pregabalin 150, gabapentin 900 - pregabalin 225, gabapentin
1800 - pregabalin 300, gabapentin 3600 - pregabalin 275 (ie jump in gabpentin dose to double at
900mg, but linear increase for pregabalin). What is the reason for this?
A) Gabapentin has a saturable absorption vs pregabalin does not
B) The is a difference in the volume of distribution (it specified which way)
C) Higher clearance for gabapentin compared to pregabalin
D) ? Difference in protein binding (could have been something else - not remembered well)
RACP 2020 Q5.
Seizure after medication noncompliance, how long of a driving restriction. Previously well
controlled for 5 years
A) 6 months
B) 12 months
C) As soon as he restarts his meds and is compliant
D) 4 weeks
ANS: D - 4 weeks
RACP 2020 Q 38.
A patient presents with persistent vertigo. What feature on examination would be most
concerning for a stroke?
A) Absence of skew deviation
B) Positive head impulse test
C) RIght-sided nystagmus with rightward gaze
D) Difficulty walking/ataxia
RACP 2020 Q47.
What are the parasympathetic cranial nerves?
A 3579
B 35710
C 35910
D 37910
RACP 2019 Question 20
Weakness of which muscle can differentiate between cortical stroke and Bell’s palsy?
A. Frontalis
B. Mentalis
C. Tarsus
D. Orbicularis
RACP 2020 Question 35
A patient with replapsing-remitting multiple sclerosis has been treated with natalizumab for 4 years. She develops new neurological symptoms and MRI shows white matter changes. Progressive
multifocal leukoencephalopathy is suspected. What is the most specific CSF test?
A. Neuron specific enolase
B. JC virus
C. Oligoclonal bands
D. 14-3-3 protein
B - detection of JC virus in the CSF
A - encephalitis
C - MS (if absent in serum), CNS infections
D - CJD
RACP 2019 Q53
Question 53
A 38 year old man presents with slowly progressive lower limb spasticity. He has a family history of primary adrenal insufficiency. His MRI Spine is normal. Which of the following is the most likely diagnostic finding?
A. Anti-neuronal anti-bodies
B. CSF Oligoclonal bands
C. Carnitine profile
D. Very long chain fatty acids
RACP 2019 Question 68
A patient presents with aneurysmal subarachnoid haemorrhage. What is the rationale for treatment
with nimodipine?
A. Prevent cerebral vasospasm
B. Reduce cerebral blood flow
C. Reduce cerebral oedema
D. Prevent aneurysm recurrence
RACP 2019 Question 69
What is the mechanism of action of ocrelizumab in the treatment of multiple sclerosis?
A. Alpha4beta1 integrin antagonist
B. Inhibits CD20
C. Sphigosine-1-phosphate receptor modulator
D. Lysing CD52 monoclonal antibody
Ans B Anti CD -20 ab
A - Natalizumab
B - also ofatumumab
C- fingolimod
D - Alemtuzumab
RACP 2019 Question 20
In Neurocognitive testing, which domain is most likely to be present in early Dementia with Lewy
body?
A. Verbal fluency
B. Recall
C. Naming
D. Clock drawing
RACP 2019 Question 52
What gene mutation is most common in Duchenne muscular dystrophy?
A. Missense mutation
B. Multi exon deletion
C. Multi exon duplication
D. Single gene insertion
RACP 2019 Question 55
A 19 year old female is admitted with meningococcal meningitis. What contact precautions are
required in the first 24 hours of her admission?
A. Negative pressure
B. Droplet
C. Airborne
D. Contact
RACP 2019 Question 56
What is the main inhibitory neurotransmitter?
A. Glycine
B. Acetylcholine
C. GABA
D. Glutamate
RACP 2018 5. A 75-year-old man presents to his local doctor with abrupt onset of painless visual blurring
affecting the left eye only, and lasting 20 minutes. On reflection, he recalls a similar episode 1 week earlier while driving, but he was able to complete his journey because vision in the right eye was unaffected. Currently, the neurological examination is normal. Which artery stenosis would be expected to cause this presentation?
A. Basilar.
B. Left carotid.
C. Left vertebral.
D. Right carotid.
E. Right vertebral.
RACP 2018 Q8.
Pizotifen is a medication used in migraine prophylaxis. Apart from drowsiness, what is the most
common adverse effect of pizotifen?
A. Hepatitis.
B. Rash.
C. Rebound headache.
D. Seizures.
E. Weight gain.
RACP 2018 Q 12
A 52-year-old man with known diabetes mellitus and hypertension presents with sudden onset of painless monocular visual loss 24 hours ago. Examination findings are as follows: left optic disc swelling seen on fundoscopy, visual acuity 6/6 on the right, 6/24 on the left; colour desaturation on the left; left relative afferent pupillary defect.
What is the most likely diagnosis?
A. Carotid artery stenosis.
B. Central retinal artery occlusion.
C. Ischaemic optic neuropathy.
D. Occipital stroke.
E. Optic neuritis.