RACP-Neuro Flashcards
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
Left Internal Carotid Artery
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
e) Trigeminal Neuralgia
An 80 year old man presents with bilateral limb weakness and pain when mobilizing that resolves when he stops and sits down. He has a history of ischaemic heart disease. He finds he is able to walk further when bent over to push his shopping trolley. Pedal pulses are present.
What is the most likely diagnosis?
A. Spinal canal stenosis
B. Osteoarthritis
C. Polymyalgia rheumatica
D. Restless leg syndrome
E. Peripheral vascular disease
A- spinal canal stenosis
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
D- immunoglobulin
This is GBS
NOT steroids
1st line- IVIG, 2 weeks of symptom onset
2nd line- plasma exchange, given within 4 weeks of symptom onset
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
C- bells palsy
it INVOLVES THE forehead
note that lateral medullary syndrome (Wallenberg syndrome) presents with
*ipsilateral facial pain/temp loss, Horners syndrome, ataxia and dysmetria, hoarseness, dysphagia
*ContralateralLoss of pain and temperature in body (spinothalamic tract).
*Other:
Vertigo, nystagmus, hiccups.
Treatment of Malaria?
Prophylaxis
o Do NOT use mefloquine for prophylaxis in the greater Mekong Subregion (Thailand, Vietnam, Cambodia, Laos and Myanmar) due to mefloquine resistance
o Atovaquone + proguanil (1-2 days before and 7 days after) OR doxycycline (starting 1-2 days before, and continue for 4 weeks after) OR mefloquine (once weekly for 2-3 weeks before and 4 weeks after)
Treatment
o Severe: IV artesunate. Increasing resistance in SE
o Otherwise: Artemether + lumefantrine OR atovaquone + proguanil OR quinine sulfate + doxy/clindamycin
o P. falciparum – single dose of primaquine (need to check G6PD as can cause haemolysis)
o P. Vivax + P ovale:
Chloroquine + add primaquine for 7-14 days. (not these drugs can cause haemolysis so need to check G6PD)
some evidence for tafenoquine
o Stand-by emergency treatment: artemether + lumefrantrine OR atovaquone + proguanil
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
E) Syringomyelia
An 89 year old female with Alzheimer’s disease comes in with delirium. She is found to be bradycardic. Which medication is most likely to be responsible?
A) Donepezil
B) ACE inhibitor
C) Prochlorperazine
D) Oxybutynin
E) Amlodipine
A) Donepezil- anti-cholinesterase –> decrease breakdown of acetocholine –> increase cholinergic activity
Eliciting hip joint pathology is best achieved by which of the following
A) Extension, external rotation, abduction
B) Extension internal rotation, abduction
C) Extension, internal rotation, adduction
D) Flexion, external rotation, abduction
E) Flexion, internal rotation, abduction
D) Flexion, external rotation, abduction
this is in the FABER test
A 72 year old patient with multiple myeloma is on treatment with bortezomib, cyclophosphamide and dexamethasone. She presents with bilateral leg weakness with decreasing sensation travelling up her legs.
What is the next immediate step in management after analgesia?
1) Bisphosphanate
2) High dose steroids
3) Radiotherapy
4) Surgery
5) Rituximab
2) High dose steroids
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
D. Very long chain fatty acids
slowly progressive lower limb spasticity + family history of primary adrenal insufficiencyraises suspicion for adrenoleukodystrophy (ALD)
This is a disorder characterized by progressive neurological degeneration due to the accumulation of very long chain fatty acids (VLCFAs).
Adrenoleukodystrophy is a X-linked recessive disorder caused by mutations in the ABCD1 gene, leading to a defect in the peroxisomal transport of VLCFAs. The accumulation of these fatty acids in tissues, including the adrenal glands and the central nervous system, causes the neurological and endocrine symptoms.
- Which cranial nerves mediate the parasympathetic outflow from the cranium?
A) III, V, VII, IX
B) III, V, VII
C) III, VII, IX, X
D) III, V, IX
C) III, VII, IX, X
- 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
C) Paroxysmal hemicrania
A) Cluster headaches - 15min - 3hr unilateral headaches associated with cranial autonomic symptoms + restlessness/agitation
B) Hypnic headaches - early morning dull bilateral headache that awakens from sleep, onset >50yrs. last 15 mins-2 hours
C) Paroxysmal hemicrania - 2 - 30min attacks of unilateral headache associated with ipsilateral cranial autonomic features + agitation/pacing
D) Trigeminal neuralgia - seconds to 10min attacks of unilateral intense pain along the trigeminal nerve distribution often triggered by touch
- What part of the brain needs to have lost function for brain death to be declared/diagnosed? (I think a legal jurisdiction such as Aus/NZ was also specified)
A) Brainstem
B) Cerebrum
C) Cerebellum
D) Whole brain
D) Whole brain
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
This question and its options were well recalled
C. CXR
likely pancoast tumour
