quiz

Question 1

A 28 year old man with neck pain has some sensory loss on the outer aspect of his left forearm and arm including the thumb. He also has weakness in flexing his left elbow. MRI imaging showed a herniated disc. Based on the man’s symptoms, the root at which level is most likely to be affected?

Answer 1

C6

thumb + index finger = C6

Question 2

A 30 year old man presented with a stab wound in his back. He has right sided weakness starting at T5 and left sided loss of pinprick sensation and temperature starting at T7.

What did the man develop?

Answer 2

Brown-sequard syndrome

Question 3

A 67 year man complains of a burning sensation down the back of both legs. The pain is not as bad when he is walking uphill.

Answer 3

lumbar stenosis

Question 4

A 45 year old call centre worker is complaining of lumbar pain for the past two months. He gets stiffness in the morning and the pain gets worse on prolonged sitting and turning over in bed.

Answer 4

mechanical back pain

Question 5

Where does blood accumulate if a rupture occurred in the bridging vein?

Answer 5

between dura + arachnoid

(subdural)

Question 6

Where does blood accumulate if a rupture occurred in the posterior communicating artery aneurysm?

Answer 6

between arachnoid + pia

(subarachnoid)

Question 7

Where does blood accumulate if a rupture occurred in middle meningeal artery?

Answer 7

between dura + pterion

Question 8

An 80-year-old ex-smoker with uncontrolled hypertension presented with the acute onset of numbness of his left arm and leg. On examination, there was decreased sensation to all his left side of the body and face.

what type of stroke has this patient had?

Answer 8

lacunar stroke

• strong association with hypertension
• present with either isolated hemiparesis, hemisensory loss or hemiparesis with limb ataxia

Question 9

A 66-year-old female with atrial fibrillation presents with dysphasia and left hemiparesis.

what type of stroke has she had?

Answer 9

Partial anterior circulation infarct

involves smaller arteries of anterior circulation

only 2 of the above criteria are present (dysphasia + hemiparesis)
would be total if homonymous hemianopia

Question 10

A 70-year-old male with left homonymous hemianopia. He has no other symptoms.

Answer 10

Posterior circulation infarct

involves vertebrobasilar arteries
presents with 1 of the following:
1. cerebellar or brainstem syndromes
2. loss of consciousness
3. isolated homonymous hemianopia

Question 11

A 25-year-old man developed a sudden onset ‘worst ever’ headache and collapsed.

what invstigation would provide the definitive diagnosis?

Answer 11

CTA

Question 12

receptive aphasia is due to a lesion in what part of the brain?

Answer 12

superior temporal gyrus

sentences make no sense, neologisms but speech remains fluid

(Wernicke’s)

Question 13

expressive aphasia is due to a lesion in what part of the brain?

Answer 13

inferior frontal gyrus

speech is non-fluent, laboured + halting
comprehension is normal

(Broca’s)

Question 14

a lesion in what part of the brain would cause nystagmus, intention tremor + dysarthria?

Answer 14

cerebellum

Question 15

which anatomical area contains the primary auditory cortex?

Answer 15

superior temporal gyrus

Question 16

which anatomical area controls the temp of the body?

Answer 16

hypothalamus

Question 17

which anatomical area contains oculomotor nucleus?

Answer 17

midbrain

Question 18

A 7 year old boy presents with progressive headache, wide based ataxia and difficulty speaking. Imaging and biopsy confirms the presence of a pilocytic astrocytoma.
most probable location of this brain tumours:

Answer 18

cerebellum

Question 19

most probable location of this brain tumours:

A 56-year-old man presented to the hospital with a seizure. He had been complaining of headaches for the past several months and has been “bumping into things”. On examination, it was revealed that he has a left superior quadrantopia. Imaging and biopsy confirmed a Glioblastoma multiforme.

Answer 19

Right temporal lobe

Question 20

most probable location of this brain tumours:
A 40 year old right-handed accountant presents with difficulty in writing and that he “wasn’t as good with numbers as before”. On examination, he had a left-right disorientation. Imaging and biopsy confirmed the presence of a meningioma.

Answer 20

Left parietal lobe

Question 21

NHS standard of care for a symptomatic, easily accessible glioblastoma in a young, fit patient?

Answer 21

maximal surgery debulking
temozolomide chemo
radiotherapy

Question 22

A 25-year-old man developed a severe headache and collapsed. Upon calling his name, he does not respond nor opens his eyes. However, when a painful stimulus is applied he internally rotates his shoulders and flexes his forearm and wrists while extending his legs.

calculate GCS

Answer 22

5

Question 23

calculate GCS

A 70-year-old woman presents with a headache and confusion, 4 weeks after she suffered from a fall. She opens her eyes spontaneously and moves her arms and legs when told to.

Answer 23

14

Question 24

calculate GCS:
A 20-year-old male presented to A&E after being in a car accident. Neurologic evaluation was as follows: he opened his eyes only to the sound of his name, he was able to localize to a painful stimulus but failed to move his arms and legs to command only. When asked where he was his reply was “my house to go”.

Answer 24

11

Question 25

A patient presents with unilateral pupil mydriasis that does not constrict to light following a car accident. On CT, an intracranial haemorrhage was identified. What is the most likely herniation to cause this?

Answer 25

uncal herniation

Question 26

A 75 year old patient presents with a progressive shuffling gait and urinary incontinence. He denies any back pain. His wife is claiming that he has been forgetting his keys and taking his medication. What is the most likely diagnosis?

Answer 26

normal pressure hydrocephalus

Question 27

A 39-year-old woman presented with severe headaches whenever she sneezed. She also had decreased sensation to pinprick over her upper back, shoulders, and upper arms. Her power in her arms was 2/5 but her lower body power was 5/5.

Answer 27

Syringomyelia

->fluid filled cyst within the spinal cord

Question 28

What is the most likely cause of this patient’s symptoms:

A 6-month-old girl presented with a head circumference rising from the 66th to the 99th percentile and failure to thrive. On examination, when the lids are retracted, the eyes look like they are sunsetting, and upward gaze is impaired.

Answer 28

Non-communicating hydrocephalus due to aqueduct stenosis

Question 29

A 56-year-old man presents with a headache, severity 10/10 with associated vomiting. On examination he has neck stiffness and photophobia.

Answer 29

Subarachnoid haemorrhage

Question 30

A 40-year-old obese lady on the contraceptive pill develops headaches first thing in the morning which are worse on coughing. She is complaining of double vision. What could be causing her diplopia?

Answer 30

sixth nerve palsy

->idiopathic intracranial hypertension

Features
headache
blurred vision
papilloedema (usually present)
enlarged blind spot
sixth nerve palsy may be present

Question 31

A 55 year old man develops diplopia after a closed head injury accident. He says the diplopia is worse when he is going down the stairs. On examination, you see he has a head tilt to the right.

Answer 31

Fourth nerve palsy

supplies superior oblique (depresses eye, moves inward)

Features
vertical diplopia
classically noticed when reading a book or going downstairs
subjective tilting of objects (torsional diplopia)
the patient may develop a head tilt, which they may or may not be aware of
when looking straight ahead, the affected eye appears to deviate upwards and is rotated outwards

Question 32

A patient develops retro-orbital pain in his right eye described as a boring, worst pain he has ever felt, lasting 20 minutes. Associated tearing of that eye and a stuffy nose. He has 10 episodes of this pain for the past week.

Answer 32

cluster headache

Question 33

A 30-year-old female presented with double vision and ataxia. Three years earlier she had an episode where she lost vision in her left eye for two weeks. On exam, she was mildly ataxic, with brisk reflexes, and both horizontal and vertical nystagmus. What is the most likely diagnosis?

Answer 33

multiple sclerosis