Neurology RACP MCQs Flashcards by Jaspreet Unknown

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

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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

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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

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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

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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)

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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

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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.

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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

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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.

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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)

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RACP 2022 70.

What deficiency causes restless leg syndrome?
a. Iron
b. Magnesium
c. Zinc
d. Copper

Ans: A

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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

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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

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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

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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

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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

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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

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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

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RACP 2022b 47. Abnormalities of which receptor is implicated in alcohol withdrawal seizures?
A. NMDA
B. GABA
C. Noradrenaline

Answer: B

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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

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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

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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

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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

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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

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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.

RACP 2018 Q27 A patient with metastatic adenocarcinoma of unknown primary involving liver and bone presents with back pain, urinary incontinence and altered sensation in the legs. Clinical examination showed reduced sensation to pin prick and light touch in both legs and perineal region. The lower limb reflexes were reduced with down-going plantar reflex. What is the most likely diagnosis? A. Cauda equina syndrome. B. Cerebral metastasis. C. Leptomeningeal carcinomatosis. D. Paraneoplastic peripheral neuropathy. E. Spinal cord compression.

RACP 2018 Q30 A 44-year-old man presents with treatment-refractory epilepsy characterised by complex partial seizures. He was admitted on Friday night following a cluster of at least four of his typical seizures, which are characterised by left-sided clonic movements and a clouding of consciousness. He appeared to be perfectly well over the weekend. Now on Monday, you are called to see him, because he is convinced that his daughter has been replaced by a robot. What is the most likely cause of his delusion? A. Interictal psychosis. B. Non-convulsive status epilepticus. C. Postictal confusion. D. Postictal psychosis. E. Schizophrenia.

RACP 2018 42. A 55-year-old woman presents to the hospital emergency department with severe right periorbital headache. On examination, there is complete ptosis on the right, the right eye is unable to move from an abducted and depressed position, and the right pupil is enlarged and minimally responsive to light. What underlying vascular cause should be suspected? A. Middle cerebral artery occlusion. B. Pontine cavernoma. C. Posterior communicating artery aneurysm. D. Transverse sinus thrombosis. E. Vertebral artery dissection.

RACP 2018 Q46 46. A 45-year-old woman presents with an acute onset of left hemiparesis. Her past medical history includes sensorineural hearing loss diagnosed at age 23, and insulin dependent diabetes diagnosed at age 30. Her brother has diabetes, and her mother has diabetes and hearing loss. What is the most likely underlying diagnosis in this family? A. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). B. Hereditary haemorrhagic telangiectasia. C. Maturity onset diabetes in the young (MODY). D. Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS). E. Wolfram syndrome.

RACP 2018 Q49 49. What is the first-line drug therapy in idiopathic intracranial hypertension? A. Acetazolamide. B. Frusemide. C. Indomethacin. D. Prednisone. E. Topiramate.

RACP 2018 Q54 54. A 50-year-old woman reports 6 months of burning pain in both feet, aggravated by contact with socks or bedsheets. Pain and temperature sensation is reduced below the knees, while proprioception, vibration and light touch sensation are preserved. Lower limb nerve conduction studies are normal. What is the most likely diagnosis? A. Cauda equina syndrome. B. Functional neurological disorder. C. Lumbosacral plexopathy. D. Small-fibre neuropathy. E. Transverse myelitis.

RACP 2018 Q70 What type of dementia is particularly sensitive to the adverse effects of antipsychotic medications? A. Alzheimer disease. B. Dementia with Lewy bodies. C. Frontotemporal dementia. D. Parkinson disease with dementia. E. Vascular dementia.

RACP 2018 Q74 74. A 45-year-old man presents with 2 weeks of right foot drop. Examination reveals numbness of the lateral aspect of the leg and weakness of ankle inversion, ankle dorsiflexion and toe extension, with normal knee and ankle reflexes. Which clinical sign suggests a diagnosis of lumbar radiculopathy rather than peroneal neuropathy? A. Ankle inversion weakness. B. Lateral leg numbness. C. Normal ankle reflex. D. Normal knee reflex. E. Toe extension weakness.

RACP 2018 Which neurological autoantibody target is associated with this condition? 93. Myasthenia gravis A. Acetylcholine receptor (AChR). B. Amphiphysin. C. Aquaporin 4 (AQP4). D. Ganglioside M1 (GM1). E. Glutamic acid decarboxylase (GAD). F. Leucine-rich, glioma inactivated 1 (LGI1). G. Myelin-associated glycoprotein (MAG). H. N-methyl-D-aspartate receptor (NMDAR).

Answer A Most common abs in MG: acetylcholine receptor antibodies (AChR-Ab) Less common: muscle-specific tyrosine kinase antibodies (MuSK-Ab), lipoprotein receptor-related protein antibodies (LRP4-Ab), or no detectable antibodies (seronegative myasthenia gravis).

RACP 2018 Which neurological autoantibody target is associated with this condition? 94. Neuromyelitis optica A. Acetylcholine receptor (AChR). B. Amphiphysin. C. Aquaporin 4 (AQP4). D. Ganglioside M1 (GM1). E. Glutamic acid decarboxylase (GAD). F. Leucine-rich, glioma inactivated 1 (LGI1). G. Myelin-associated glycoprotein (MAG). H. N-methyl-D-aspartate receptor (NMDAR).

RACP 2017 A 74-year-old man present for review after developing blurring of vision in his left eye for 20 minutes, which has now resolved. He had a similar episode whilst driving two weeks ago, but reports being able to continue driving as his right eye was unaffected. His neurological examination is unremarkable. He likely has a stenosis of which artery? a) Basilar Artery b) Right Internal Carotid Artery c) Left Internal Carotid Artery d) Left Vertebral Artery e) Right Vertebral Artery

RACP 2017 Q13 A 70-year-old male presents with increasing hallucinations on a background of Idiopathic Parkinson’s Disease. His mobility is at baseline and he is otherwise functioning well. He is on Metoprolol 50 mg BD and Levodopa/Carbidopa. What is the next best step to manage his hallucinations? a) Decrease metoprolol dose b) Decrease Levodopa/Carbidopa dose c) Start Entacapone d) Start Clozapine e) Start Quetiapine

RACP 2017 Q17 An 82-year-old woman is brought to the emergency department after collapsing at a bus stop. She was witnessed to have 4-5 jerking movements of her arms and legs. She was unconscious for a total of 10 seconds. She now feels fine. What is the most likely underlying diagnosis? a) Arrhythmia b) TIA c) Vasovagal syncope d) Seizure e) ACS

RACP 2017 Question 18 A 72-year-old female has a two-week history of episodes of shooting pain affecting her cheek and jaw. The episodes last 30 seconds and she had dozens per day. They are brought on by chewing or talking. She has a normal neurological examination. What is the most likely diagnosis? a) Giant Cell Arteritis b) Hemifacial Spasms c) Migraine d) Transient Ischaemic Attack e) Trigeminal Neuralgia

RACP 2017 Question 25 Apart from Primidone, which of the following medications would be appropriate for management of an essential tremor? a) Clonidine b) Propranolol c) Diltiazem d) Amantadine e) Pramipexole

RACP 2017 Question 34 What is the aim of non-invasive ventilation in Motor Neuron Disease with bulbar involvement? a) Improve quality of life b) Prolonged functional lifespan c) Reduction in rate of aspiration d) Reduction in rate of pneumonia e) Decreases progression of respiratory muscle dysfunction

RACP 2017 Question 57 A 68-year-old man presents with his wife to Neurology Clinic. His wife has noted 12 months of gait disturbance and urinary incontinence. She describes some that he has been forgetful and mentally slower than usual in the past few months. The patient’s gait is broad based and unsteady. CT images of the brain are demonstrated below. What is the most likely diagnosis? a) Colloid cyst in the third ventricle b) Idiopathic Intracranial Hypertension c) Idiopathic Parkinson’s Disease d) Dementia with Lewy Bodies e) Normal pressure hydrocephalus

RACP 2017 Q64 Question 64 A 45-year-old male wakes up after sleep and is noted to have a severe right wrist drop with weak finger extension and finger abduction. He has a slightly weak triceps reflex but all other reflexes are normal and there are no sensory changes of note on examination. He cannot remember which side he slept on. Where is most likely site of the lesion? a) Ulnar Nerve b) Radial Nerve c) Posterior Cord of the Brachial Plexus d) Corticospinal Tract e) C7 nerve root

RACP 2017 Q71 Question 71 A man with a background of metastatic adenocarcinoma of unknown primary presents with decreased sensation in his lower limbs, urinary incontinence, reduced reflexes and a down-goingplantar response bilaterally. What is the most likely diagnosis? a) Cauda Equina Syndrome b) Spinal Cord Compression c) Paraneoplastic Peripheral Neuropathy d) Cerebral metastasis e) Leptomeningeal Carcinomatosis

RACP 2017 Q74 Question 74 A 50-year-old woman presents with a right peri-orbital headache. On examination, there was reduced light reflex in the right eye and the right eye was in an inferolateral abducted position. What is the most likely cause of her symptoms? a) Vertebral Artery Dissection b) Posterior Communicating Artery Aneurysm c) Middle Cerebral Artery Occlusion d) Transverse Venous Sinus Thrombosis e) Pontine Cavernoma

RACP 2017 Q85 Question 85 A 78-year-old man from aged care hostel is sent to hospital by the manager as he has been noted to have intermittent confusion and memory deficit. He has been described to have distressing visual hallucinations involving ninjas. Examination reveals a dishevelled man with urine and food stained clothing. Deficits on MMSE are in orientation, recall and registration. What is most likely diagnosis? a) Dementia with Lewy Bodies b) Idiopathic Parkinson’s Disease c) Normal Pressure Hydrocephalus d) Drug Induced Parkinsonism e) Frontotemporal Dementia

RACP 2017 Q8 Question 8 Marked rigidity, immobility and confusion after the administration of neuroleptic medications such as Risperidone is most suggestive of which type of Dementia? a) Alzheimer’s Dementia b) Dementia with Lewy Bodies c) Frontotemporal Dementia d) Korsakoff Syndrome e) Vascular Dementia

RACP 2017 Q15 In clinical trials of dementia patients, Acetylcholinesterase Inhibitors have demonstrated most benefit in which patient group? a) Dementia with Lewy Bodies b) Alzheimer’s Dementia c) Frontotemporal Dementia d) Parkinson’s Disease Dementia e) Vascular Dementia

RACP 2017 Q18 Question 18 Amyloid precursor protein mutations have been associated with some subsets of Alzheimer’s Dementia. On which chromosome is the amyloid precursor protein gene located? a) 3 b) 12 c) 17 d) 18 e) 21

RACP 2017 Q25 Question 25 Chemotherapy induced nausea is a common clinical problem. What receptor does the neurotransmitter Substance P act on? a) GABA-A b) Neurokinin-1 c) Dopamine d) 5HT 3 e) Histamine

RACP 2017 Q32 Question 32 Which of the following is/are the major protein(s) that are abnormally deposited in Alzheimer’s Dementia? a) Tau protein b) β-amyloid and Tau protein c) α-synuclein d) α-synuclein and Tau protein e) 14-3-3 protein

RACP 2017 Q35 Question 35 A young man with Epilepsy experiences olfactory hallucinations and a rising sensation in his epigastrium. Where is the most likely source of the seizure activity? a) Frontal lobe b) Temporal lobe c) Parietal lobe d) Occipital lobe e) Thalamus

RACP 2017 Q65 Deposition of abnormal proteins is implicated in many neurodegenerative disorders. Which protein are Neurofibrillary Tangles composed of? Options a) α-synuclein b) Tau protein c) β-amyloid e) Hyaline f) Ubiquitin g) Huntingtin protein h) 14-3-3 protein

RACP 2017 Q66 Deposition of abnormal proteins is implicated in many neurodegenerative disorders. Which protein is predominant in Dementia with Lewy Bodies? Options a) α-synuclein b) Tau protein c) β-amyloid e) Hyaline f) Ubiquitin g) Huntingtin protein h) 14-3-3 protein

RACP 2016 PAPER A Question 4 A 24yo Brazilian female presents to ED following a seizure that occurred during sleep. On arrival she feels completely well/back to her usual self and she has no abnormal neurological findings on examination. She appears to be of normal intellect. A CT of her brain (shown below) shows a single calcified lesion. What is the most likely diagnosis? A. Metastatic melanoma B. Neurocysticercosis C. Oligodendroma D. Tuberous sclerosis E. Herpes simplex

RACP 2016 Q14 Question 14 A 25 male presents with cafe au lait spots and axillary freckles. He has a family history of neurofibromatosis type 1. He has a supraclavicular mass which has increased in size over 2 months from barely noticeable to 5x3x3cm. It is painful and non-mobile. There is no associated weight loss or fevers. What is the likely diagnosis? A. Lipoma b. Malignant neurofibroma C. Metastatic thyroid cancer D. Neurofibroma E. Lymphoma

RACP 2016 a Question 18 Which cranial nerves would you expect to be affected by the macroadenoma as shown in the MRI image of the pituitary gland? A. I & II B. II C. I, II, & III D. II, III, & IV E. II, IV, V1

RACP 2016a Question 29 The clinical features of Rapid Eye movement behaviour syndrome often precede the development of which neurological disorder? A. Alzheimer’s Disease B. Multiple Sclerosis C. Huntington’s Disease D. Progressive Supranuclear Palsy E. Parkinson’s Disease

RACP 2016a Question 34 74yo male presents with fall preceded by 60 mins of positional vertigo and nausea. History of same intermittently for 10 years. Describes feeling of "fullness" in right ear. Examination revealed horizontal nystagmus which was suppressed on visual fixation, decreased hearing in right ear. Most likely diagnosis? A. BPPV B. Ménière's disease C. Vertebrobasilar TIA D. Acoustic neuroma E. Vestibular neuritis

RACP 2016a Question 40 A 25 year old man who is previously health presents with bilateral leg weakness and tingling, which has now also progressed to involve his arms. He suffered from a respiratory tract infection two weeks ago. On examination the lower limbs the deep tendon reflexes are absent What treatment will result in faster recovery in his condition? A. Cyclophosphamide B. Steroids C. Neostigmine D. Immunoglobulin E. Rituximab

RACP 2016a Question 47 A 70 year old lady presents after waking with right sided facial weakness, with associated dribbling from her mouth and difficulty closing her right eye. She reports having received cosmetic botox injections 1 month prior. On examination she has facial weakness involving muscles of her right face including the forehead. There were no visual field deficits and she had normal upper and lower limb neurological examinations. What is the likely cause of her illness? A) Lateral Medullary Syndrome B) Left MCA territory infarct C) Bell’s palsy D) Iatrogenic weakness post injection E) Rubarb

RACP 2016a Question 54 A 60 year male is found to weakness biceps femoris, anterior tibilalis and flexor carpus radialis. This is most consistent with? A) Inclusion body myositis B) Statin myopathy C) Polymyositis D) Dermatomyositis E) Necrotising autoimmune myositis

Answer A IBM Inclusion body mysotitis (IBM) has asymmetric muscle involvement, Distal muscles as well as proximal muscles involved Flexors of the hand and quadriceps are often first involved Cricopharyngeal muscles affected in 50% - dysphagia and aspiration risk

RACP 2016a Question 57 A 32 year old female presents with a gradual history of progressive shoulder and neck discomfort. On examination she has loss of pain and temperature on her upper arms and torso bilaterally. Light touch and vibration are normal. Neurology is normal below this level. What is the most likely diagnosis? A) Congenital spinal artery stenosis B) MS C) GBM D) Spinal meningioma E) Syringomyelia

RACP 2016 Question 69 A 74 year old woman with previously well controlled Parkinson’s disease on Levodopa, Carbidopa, and Selegiline develops strong paranoid visual and auditory hallucinations, and becomes increasingly psychotic. What is the most appropriate course of action? A) Stop Levodopa + Carbidopa B) Stop Selegiline C) Start Quetiapine D) Start Clozapine E) Start Deep Brain Stimulation

RACP 2016b Question 19 Which of the following clinical features would make you suspect Dementia with Lewy Body rather than Alzheimer’s? A. Short term memory loss B. Visual hallucinations C. Incontinence D. Aggression E. Constipation

RACP 2016b Question 23 54 year old man presents with bilateral proximal muscle weakness. His CK is elevated at 3400 U/L (< 250 U/L). Muscle biopsy demonstrates muscle necrosis without inflammation. What is the most likely diagnosis? A. Dermatomyositis B. Mitochondrial myopathy C. Necrotising autoimmune myopathy D. Polymyositis E. Viral myositis

Answer C Necrotising myopathy Biopsy shows myonecrosis without inflammation Rapidly progressing proximal muscle weakness Myalgia Limited extra-muscular features and systemic involvement Significantly elevated CK

RACP 2016b Question 48 Which two proteins paired together are responsible for the pathological process of Alzheimer’s disease? A) Alpha synuclein and Lewy Body fibrils B) Beta amyloid and tau protein C) Fibrillin and CRP D) Alpha synuclein and CRP E) Huntingtin protein and lewy body fibrils

Answer C Biopsy shows myonecrosis without inflammation

RACP 2016b Question 54 Cervical spine injury is a common cause of diaphragmatic palsy. What spinal routes innervate the diaphragm? A) C2-4 B) C1-3 C) C3-5 D) C4-6 E) C5-7

RACP 2016b Question 69. Which of these anti-epileptics has the longest half life? A) Phenytoin B) Gabapentin C) Oxycarbazepine D) Carbamazepine E) Lamotrigine F) Topiramate G) Valproate

RACP 2016b Question 70. Which one of the following medications induces its own metabolism? A) Phenytoin B) Gabapentin C) Oxycarbazepine D) Carbamazepine E) Lamotrigine F) Topiramate G) Valproate

RACP 2015 Q 16 Question 16 A 42 year old female has been referred to a neurologist with a 6 month history of abnormal lower limb movements. She describes jerky movements bilaterally involving her lower limbs which occurs at rest and whilst watching television. Her husband reports that she kicks him in her sleep. Neurological examination is normal. What is the most likely diagnosis? A. Amyotrophic lateral sclerosis B. Huntington's disease C. Juvenile myoclonic epilepsy D. Restless leg syndrome E. Tourette's syndrome

RACP 2015 Q34 Question 34 A 24 year old woman is brought to the emergency department after a collapse. She is able to describe a period of 10 seconds of lightheadedness and dimmed vision prior to losing consciousness. She was witnessed to have several symmetrical convulsions and urinary incontinence during the episode. There was no evidence of tongue-biting. She fully regained consciousness and was back to her normal self after a further minute. What is the most likely cause of her collapse? A. Cataplexy B. Conversion disorder C. Epileptic seizure D. Syncope E. Transient ischaemic attack

RACP 2016 Q51 Question 51 A 46 year old lady presents to the clinic, complaining of hand numbness. She is known to have seropositive rheumatoid arthritis and is treated with methotrexate, leflunomide and prednisone. On examination, she is found to have sensory loss over the palmar aspect of the thumb, index, middle and radial surface of the ring finger. She also has weakness of wrist flexion. The most likely cause of her symptoms is: A. Carpal tunnel syndrome B. C6 radiculopathy C. Pronator syndrome D. Drug related neuropathy E. Vasculitis

RACP 2015 Question 95: Elderly gentleman with disinhibition, etc. A. Lewy Body Dementia B. Parkinson’s Disease C. Alzheimer’s Disease D. Frontotemporal Dementia E. Progressive supranuclear palsy F. Multiple system atrophy G. Mild cognitive impairment

RACP 2015 Q96 Sixty year old female with gradual deterioration in behavior. Episodes noticed by family of looking blank. Visual hallucinations. Slowing of walking and 2 falls in past 6 months. A. Lewy Body Dementia B. Parkinson’s Disease C. Alzheimer’s Disease D. Frontotemporal Dementia E. Progressive supranuclear palsy F. Multiple system atrophy G. Mild cognitive impairment

RACP 2015 Q37 Question 37 In patients with increased ICP, non-invasive ventilation can be used to decrease ICP temporarily. What is the mechanism behind NIV for increased ICP? A. It causes cerebral vasoconstriction B. It increases meningeal compliance C. It decreases cerebral oedema D. It increases CSF resorption E. It decreases CSF secretion

RACP 2015 Q51 Question 51 Which of these antiepileptics can cause psychological disturbances? A. Carbamazepine B. Pregabalin C. Topiramate D. Phenytoin E. Levetiracetam

RACP 2015 A man in his 20s is brought hospital after becoming unrousable at the pub. His friends say he had only had 2 drinks. He had recently been well, but was struck on the head by a cricket ball during their game that afternoon. He was knocked to the ground but was not unconscious, and continued to bat afterwards. What is the most likely pathology? A. Acute extradural haematoma B. Chronic extradural haematoma C. Acute subdural haematoma D. Chronic subdural haematoma E. Subarachnoid haemorrhage

RACP 2015 A 59 year old woman presents to the emergency department with a sudden onset headache, which she describes as feeling like she has been struck on the head with a brick. She presented 2 weeks earlier with a similar headache. She also states that the headache is worse on bending over to pick up her bag. Non-contrast CT brain on this and the previous presentation was normal. What is the most useful diagnostic test for her? A. CT cerebral angiogram B. Digital subtraction angiogram of the cerebral vessels C. MRI cerebral angiogram D. Lumbar puncture E. CT venogram

RACP 2015 Question An 82 year old lady with Parkinson's disease and mild cognitive impairment is in hospital for a urinary tract infection. Her husband died 2 years ago, and for most of that time she reports she has had pleasant visual hallucinations of him standing at the end of her bed at night, which she finds reassuring. In the last 2 days, she reports being very distressed at hearing people talking at night about wanting to kill her. What is the most likely cause of this? A. Delirium B. Dopamine agonists C. Psychotic depression D. Antibiotics E. Worsening Parkinson’s Disease

RACP 2015 A man presents complaining of restless legs. Which nutrient deficiency is he most likely to have? A. Folate B. B12 C. Iron D. Vitamin C

RACP 2014 Question 1: A 30 year old female with MS presents to hospital with pneumonia. Her temperature on admission is noted to be 39C. The next day, the vision in her left eye that has previously been affected by her MS is worse. What is the reason for the change in her vision? 1. Progression of MS 2. High temperature 3. Infection of the optic nerve 4. Ischaemic optic neuropathy 5. Post-infectious flare of optic neuritis

RACP 2014 Q 20. Patients with atrial fibrillation are at increased risk of stroke. Of the following, which feature carries the highest risk? a) Hypertension b) Congestive Cardiac Failure c) Previous stroke d) Age > 75 e) Left atrial enlargement

RACP 2014 Question 25 Which of these is a feature of subcortical dementia rather than cortical dementia? a. agnosia b. alexia c. aphasia d. apraxia e. apathy

RACP 2014 Q32 Question 32 What is the afferent nerve of the cough reflex? A - glossopharyngeal B - Hypoglossal C - Vagus nerve D - Phrenic nerve E - Recurrent laryngeal nerve

RACP 2014 Q54 Patient with 3 day h/o lower limb weakness, distal power 3/5, proximal 4/5, no reflexes, subjective loss of sensation in both feet. Which nerve fibres are affected in this pathology? A. C fibre B. Large myelinated C. Large unmyelinated D. Small myelinated E. Small unmyelinated

RACP 2014b Question 2: A 65yo man from a homeless shelter is brought into ED with ataxia, confusion, and an opthalmoplegia with difficulty in lateral gaze. This has partially corrected with hospital management (no details on what management was instituted). Which of the following is likely to be present post resolution of the acute symptoms? a) Amnesia b) Speech disturbance c) Chronic dementia d) Visuospatial disturbance e) Calculation problems

RACP 2014b Question 15 A 75 year old woman is transferred from her nursing home with confusion over the past three days. She has moderate dementia. What is the best way to differentiate dementia and delirium? A. Attention and calculation B. Language C. Short-term memory D. Visuospacial difficulties E. Orientation

RACP 2014b Question 35 A 28 year old man presents with left ear pain and left sided facial weakness (see below). What is the appropriate treatment? A. Aciclovir B. Aspirin C. Acupuncture D. Gabapentin E. Prednisone

RACP 2014 Q43 A 65 year old pilot presents for a routine medical examination in order to renew his pilots license. A 70% Internal Carotid Artery Stenosis was found on the right side. He complains of no symptoms and has no history of TIA or stroke. What is the most appropriate management? A - aspirin and clopidogrel B - Aspirin alone C - Anticoagulate D - Endarterectomy E - Stent

RACP 2014 Lady BMI 32 or 36, presents with headaches (worse in the morning). Also notices visual dimming when standing from squatting position. She is 5 weeks post partum. Diagnosis? 1. Venous thrombosis 2. Migraine 3. CVA

RACP 2014 A 26 year old male is drinking after a cricket game with his friends when he notices he is unable to stand. On examination he has right face, arm and leg weakness, diplopia and a left sided parietal bruise. His friends volunteer his was hit by a cricket ball during the game earlier that morning but was fine afterwards. What is the most likely finding on CT brain? A. Subdural haematoma B. Epidural haematoma C. Vertebral artery dissection D. Carotid artery dissection E. Intracerebral haemorrhage

RACP 2014 Q80. A 79yo woman presents with dizziness for 3 weeks, exacerbated by driving in a car. Her symptoms started after a hospital admission 3 weeks ago for an elective total hip replacement, complicated by multiple episodes of Urosepsis. On examination she had positive vestibulo- ocular reflexes bilaterally. She is mildly Rhomberg's positive. Deep tendon reflexes were normal. What is the most likely cause of her symptoms? A) Meniere's disease B) Vestibular neuronitis C) BPPV D) Gentamicin-related vestibulopathy E) Posterior circulation infarct

RACP 2013 Question 3 Which of the following electrolyte abnormality is more likely to precipitate encephalopathy in the setting of hyper ammonaemia? A. Hypokalaemia B. Hyponatraemia C. Hypomagnaesaemia D. Hypophosphataemia

RACP 2013 Question 5 The most common cause of epilepsy in elderly patients (aged 75 & above) is: A. Tumour B. Previous strokes C. Genetic D. Previous head trauma

RACP 2013 Question 21 54yo female with past history of breast cancer gradually developed a movement disorder characterized by impaired movement of her right arm. When she tried to move her arm she is clumsy and there are exaggerated flinging movements. The same tendency is seen in the right lower leg but much to a lower extent. The rest of her neurological examination is within normal limits. This syndrome is associated with a lesion in which of the following sites of the brain? a) Caudate nucleus b) Pre motor cortex c) Subthalamic nucleus d) Lateral cerebellum e) Temporal lobe

RACP 2013b Question 8 A 65 year old male presents to clinic reporting an 18 month history of memory impairment. He has caused some consternation recently by forgetting to attend his daughter’s wedding. He continues to golf, garden and is able to manage his finances independently. On examination his MMSE is 27/30, with all points lost for short-term recall. MRI brain shows periventricular white matter changes. What is the most likely diagnosis? A. Alzheimer’s dementia B. Frontotemporal dementia C. Mild cognitive impairment D. Normal ageing E. Vascular dementia

RACP 2013b Question 10 A 65yo man from a homeless shelter is brought into ED with ataxia, confusion, and an opthalmoplegia with difficulty in lateral gaze. This has partially corrected with hospital management (no details on what management was instituted). Which of the following is likely to be present post resolution of the acute symptoms? a) Amnestic MCI b) Speech disturbance c) Chronic dementia d) Visuospatial disturbance e) Calculation problems

RACP 2013b Question 14 54F with known breast cancer develops progressive motor disorder with impairment of right arm function. She is clumsy with all movements and exaggerated ‘flinging’ actions are noted on examination. There is a similar pattern in the right leg with to a much lesser extent. There are no other abnormalities on neurological examination. Where is the most likely site of the lesion? A. Caudate nucleus B. Lateral cerebellum C. Pre-motor cortex D. Sub-thalamic nucleus E. Temporal lobe

RACP 2013b Question 28 An 18yo male gives a history of early morning ‘jerking’ movements of his arm. After a night of heavy drinking and sleep deprivation, he has a generalised tonic-clonic seizure at 5am. An EEG reveals generalised spike and wave discharges. What is the most appropriate choice of anti-epileptic? A. Carbamazepine B. Ethosuximide C. Sodium valproate D. Gabapentin E. Phenytoin

RACP 2013b Question 38 A 25 year old secretary presents with excessive daytime sleepiness, vivid dreams at the onset of sleep and the sensation of her legs "giving way" with laughter or emotional response. She does not take any medications and has no other medical history. She reports that she has to consume caffeine-containing beverages to maintain alertness at work. Which of the following investigations would be most likely to provide a diagnosis: A) MRI of brainstem B) Maintenance of wakefulness test C) Mean sleep latency test D) Overnight polysomnography E) Sleep deprived EEG

RACP 2013b Question 40 Mrs Higginbottom is on natalizumab for multiple sclerosis. She reports feeling “a wee bit off, love.” She thus has an MRI brain which looks like this: What is the best test to diagnose her brain infection? a. Cryptococcal antigen. b. Toxoplasma culture c. John Cunningham virus PCR d. Herpes simplex 1 virus PCR e. Mycoplasma culture

Answer C: JC virus PCR to diagnose PML

RACP 2013b Question 42 A 20M presents with a series of ‘funny turns’ for the last 2 months. They begin with an odd taste in his mouth, followed by nausea, headache and fatigue. He occasionally uses marijuana and drinks 3-5 standard drinks per week. What is the most likely cause of these episodes? A. Cannabis toxicity B. Hippocampal sclerosis C. Migraine D. Panic disorder E. Somatisation

RACP 2013b Question 43 An 80F presents with worsening hallucations. She has severe Parkinson’s disease and is bed bound in high level care due to poor mobility. Her medications are levodopa / benserazide 100/25 QID and oxycodone SR 5mg bd. She is not constipated and there is no evidence of infection or underlying metabolic disturbance. What is the best strategy to reduce her hallucinations? A. Reduce levodopa / benserazide dose B. Reduce oxycodone SR dose C. Commence haloperidol D. Commence quetiapine E. Commence lorazepam

RACP 2013b Question 60 A 45yo male patient has a glioblastoma multiforme removed neurosurgically. Which of the following is the next step in his post-operative care? A) Chemotherapy B) Radiotherapy C) Chemo-radiotherapy D) No further therapy needed E) Biological agents

RACP 2013b Question 62 What is the most common neuropsychiatric manifestation of SLE? A) Depression B) Seizures C) Mania D) Impaired cognition E) Headache

RACP 2013b Question 63 A 78yo highly educated lady from home is with her daughter and brought in with a 4 day history of hallucinations and restlessness. MMSE is 27/30. What is the likely diagnosis? A) Delirium B) Dementia C) Mild cognitive impairment D) Depression E) Stroke

RACP 2013b Question 93 An 18year old female presents with a tonic-clonic seizure follow by ?akathesia, hypertension and agitation on a background of a recent flu-like illness within the week prior. She is otherwise healthy with nil known medical history. An MRI (shown) is significant for increased enhancement of the temporal lobes bilaterally. CSF reveals a lymphocytes count of 8, normal protein. HSV PCR is negative. After excluding an infectious cause, which of the following is most likely diagnosis: A) Amphetamine use B) Ischaemic stroke C) Limbic encephalitis D) Primary epilepsy E) Hippocampal sclerosis

RACP 2013b Question 94 A 53 year old man collapses onto his desk at work. He is rushed to hospital and upon waking has a severe headache and is very drowsy. He has a cranial nerve palsy. A non-contrast CT scan of his head reveals hyperdensity within the ventricles. What is the most significant complication of this condition? A. Swelling due to vasospasm B. Increased CSF volume due to vasodilatation C. Increased bleeding from circulating anticoagulants D. Vessel inflammation leading to infarcts E. Blood clots obstructing CSF flow

RACP 2013b Question 95 A 42 year old female presents with difficulty walking. On examination she is found to have a left sided foot drop and on further history she has experienced abdominal pain after eating. Investigations reveal dsDNA of 7, RF negative, ANCA negative raised CRP. What is most likely to yield a diagnosis? A. Sural nerve biopsy B. ESR C. Nerve conduction studies D. MRI E. CT angiography of the abdomen

RACP 2013a Question 19 Involvement of VZV in which nerve would result in a presentation that mimics meningitis? a) Trigeminal nerve (mandibular branch) b) Trigeminal nerve (ophthalmic branch) c) Facial nerve d) Glossopharyngeal nerve e) Occipital nerve

Answer B Trigeminal V1 Varicella-zoster virus (VZV) reactivation involving the trigeminal nerve, specifically the ophthalmic branch (V1), can cause herpes zoster ophthalmicus. This condition can present with symptoms mimicking meningitis, including: - Severe headache - Fever - Photophobia - Eye pain - Cranial nerve involvement (e.g., third, fourth, or sixth nerve palsy)

RACP 2013a Question 42 Where is the centre for control of appetite and satiety? A) Amygdala B) Hypothalamus C) Frontal lobe D) Pons E) Anterior pituitary

Answer B - hypothalamus