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Year 3 Exams: Neurology > Revision Questions > Flashcards

Revision Questions Flashcards

1
Q

You are the FY1 on call in the paediatric ward. You are called to see an infant who is reported to have been irritable and has had poor feeding. On examination you notice splaying of the cranial sutures, with tense bulging fontanelles. Given the likely diagnosis, which of the following additional clinical features might you expect?
Select one or more:

a. Trigeminal Neuralgia
b. Macroglossia
c. Abducens nerve palsy
d. Cranial Enlargement

A

Abducens nerve palsy and Cranial Enlargement

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2
Q

A 55-year-old woman presents 7 hours after developing left arm weakness that has persisted. Neuroimaging excludes a haemorrhage, what is the most appropriate management?

A

Aspirin 300mg + supportive therapy

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3
Q

A 63 year old man presents with a left sided hemiparesis which affects his lower limb more than his upper limb, with his face unaffected. He also has complete loss of both pain and light touch sensation in his left lower limb. He is able to clearly speak to you but understands what you say. He does not have an ataxia, but he appears unable to see you when you stand on his left. Clinical examination of his visual fields reveals a left sided homonymous hemianopia.
Which clinical stroke syndrome does he have?

A

Partial anterior circulation infarct (PACI)

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4
Q

What proportion of strokes are ischaemic?

A

85%

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5
Q

79 year old lady had a stroke 4 days ago. Which of the following is the strongest risk factor for a hemorrhagic stroke?

A

Apixaban

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6
Q

You review an 80-year-old woman four days after she was admitted with a suspected stroke. She has a right sided sensory loss affecting her arms more than the legs and a right sided homonymous hemianopia. What area is the stroke most likely to have affected?

A

Middle Cerebral Artery

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7
Q

Name 5 Causes of Secondary Headaches?

A 
Carbon Monoxide Poisoning
Meningitis
Subarachnoid Haemorrhage
Mengioma
Toxoplasmosis
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8
Q

A 45 year old lady with a diagnosis of Marfan’s disease is referred to the headache clinic. She has been experiencing headaches for 2 weeks. The headache is worse when she stands up and only goes away when she lies down. As a result she has been spending the last week in bed as she cannot cope with the pain. What is the most likely diagnosis?

A

Intracranial Hypotension

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9
Q

Name red flags for headaches (3)

A

Sudden Onset
Non Blanching Rash
Impaired Level of Consciousness

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10
Q

Name this type of headache

Pain typically occurs once or twice a day, each episode lasting 15 mins - 2 hours with clusters typically lasting 4-12 weeks. Intense pain around one eye (recurrent attacks ‘always’ affect same side) accompanied by redness, lacrimation, lid swelling

A

Cluster

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11
Q

Name this type of headache

Recurrent, non-disabling, bilateral headache, often described as a ‘tight-band’

A

Tension

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12
Q

Name this type of headache

Present for 15 days or more per month. Developed or worsened whilst taking regular symptomatic medication

A

Medication Overuse

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13
Q

Name this type of headache

Intense facial pain ‘electricity-like-shooting pain’ that comes on spontaneously and lasts anywhere between a few seconds to hours. Pain is provoked by chewing, shaving, washing and talking.

A

Trigeminal Neuralgia

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14
Q

Name this type of headache?

Recurrent, severe headache which is usually unilateral and throbbing in nature. May be be associated with aura, nausea and photosensitivity

A

Migraine

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15
Q

What drug can be used as migraine prophylaxis in a pregnant woman?

A

Propranolol

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16
Q

How to treat raised intracranial pressure?

A

Lumbar Puncture

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17
Q

Characteristic features of Hydrocephalus in infant? (3)

A

Enlarged Cranium
Swollen Fontanelles
Splaying Sutures

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18
Q

Which nerve palsy would you expect in Hydrocephalus?

A

Abducens Nerve Palsy

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19
Q

Where would we perform a lumbar puncture in adult?

A

L3-4

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20
Q

Which level does spinal cord end in adult?

A

L2

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21
Q

Name contraindications for lumbar puncture? (7)

A 
Raised ICP
Raised Intracranial Bleed
Bleeding Disorder
Head Trauma
Localised Infection over skin site
Focal Neurological Deficit
Papilloedema
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22
Q

An obese pregnant female presents with ongoing headache and visual disturbance. On Examination you notice that she is unable to look laterally with her right eye. On fundoscopy she has papillodema. She reports no other clinical features and her only other PMH is a diagnosis of bipolar disorder for which she was prescribed lithium. She recently stopped taking lithium when she found out she was pregnant.
What is the most likely diagnosis?

A

Idiopathic Intracranial Hypertension

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23
Q

How does raised ICP present? (4)

A

Headache
Visual Disturbance
Papilloedema
6th Nerve Palsy

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24
Q

The use of which psychiatric drug can lead to Idiopathic Intracranial Hypertension?

A

Lithium

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25
Q

Headache following lumbar puncture (LP) occurs in around one-third of patients and is more common in females with low BMI. Typical features of post-LP headache are: typical comes on within 24-48 hours following LP but may occur up to one week later and may last several days. The headache is worse in the upright position and improves in the recumbent position. What factors may contribute to the headache? (2)

A

Increased Needle Size

Increased Number of LP Attempts

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26
Q

What is the most likely vessel damaged in an Extradural Haemorrhage?

A

Middle Meningeal Artery

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27
Q

Mr Smith presents to his GP with a one day history of ophthalmoplegia and double vision. He was diagnosed with MS two years ago, this is his 3rd acute relapses since the time of diagnosis. What drug might reduce the length of his relapse?

A

Prednisolone

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28
Q

Which investigation is most appropriate for diagnosis of Multiple Sclerosis?

A

MRI with contrast should be used to view demyelinating lesions

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29
Q

Jessica is 26year old lady present to A&E following a seizure. Her football coach has come with her in the ambulance. Her coach describes the incidents from today to the admitting doctor: Jessica received a tackle late into the first half of the match. The tackle resulted in both women knocking their heads together. Jessica was unconscious immediately after the knock to the head for about 1 minute but then got up on her own. She promised that was feeling fine to go on for the second half. However, after about 5 mins of playing Jessica had to come off the pitch as she said she was feeling sick. She sat down on the bench and then collapsed. She was seizing for 3 minutes before the ambulance arrived.
What is the most likely diagnosis?

A

Extradural Haemorrhage

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30
Q

Sheila is a 65year old lady who was diagnosed with MS 25 years ago. Since the time of her diagnosis she has had weeks where she describes that her MS would flare then get better. She now presents to the GP because it has been 10 weeks since her most recent flare (bladder incontinence and gait abnormalities) and despite treatment she feels her symptoms are only getting worse as the weeks go on.
What pattern of disease does Sheila?

A

Previously had Relapsing-remitting disease but has now developed secondary progressive disease

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31
Q

A 40-year-old woman presents with a variety of symptoms including generalised skin tingling and headache. On examination she has hyperreflexia, spastic weakness and upgoing plantars. You consider the possibility that she has multiple sclerosis. What is the most common presentation of multiple sclerosis?

A

Optic Neuritis

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32
Q

Which one of the following is a typical CSF result for viral meningitis?

A

CSF clear, protein normal, glucose slightly raised, white cell count high (lymphocytes)

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33
Q

An 18 year-old with no significant medical history registers at a new GP practice when he moves to University. The practice reviews his immunisation history and sends him an invitation to have a vaccination.
Which of the following vaccinations should he receive if he has not had it previously?

A

MEN ACWY

34
Q

Meningoencephalitis is a complication most associated with which one of the following conditions?

A

Mumps

35
Q

A 31-year-old woman presents to the Emergency Department complaining of a headache. She has had ‘flu’ like symptoms for the past three days with the headache developing gradually yesterday. The headache is generalised and she is experiencing photophobia. On examination her temperature is 38.2º, pulse 96/min and blood pressure 116/78 mmHg. There is neck stiffness present but no focal neurological signs. On close inspection you notice a number of petechiae on her torso. She has been cannulated and blood (including cultures) have been taken.
What is the most appropriate next step?

A

IV cefotaxime

36
Q

A 24-year-old man was admitted overnight with suspected meningitis. You are asked to review the initial microscopy results from the lumbar puncture. The culture is growing gram negative diplococci.
What is the most likely organism?

A

A 24-year-old man was admitted overnight with suspected meningitis. You are asked to review the initial microscopy results from the lumbar puncture. The culture is growing gram negative diplococci.
What is the most likely organism?

37
Q

A 15-year-old boy presents to the emergency department with a headache and photophobia. On examination the doctor notices a purpuric rash on his chest. He has a respiratory rate of 22/min, a heart rate of 140/min and a blood pressure of 80/60 mmHg

Which test is a contraindication to lumbar puncture?

A

Meningococcal septicaemia

38
Q

Contraindications for Lumbar Puncture? (6)

A

Meningococcal septicaemia

Focal Neuro Signs

Papilloedema

Significant Bulging of Fontanelle

Disseminated Intravascular Coagulaion

Signs of Cerebral Herniation

39
Q

What is the most likely causative organism in neonatal meningitis?

A

Group B Streptococcus

40
Q

A 32-year-old woman visited her GP two weeks ago complaining of thick green nasal secretions, a fever and facial pain. There is tenderness on palpation of the maxillary and frontal sinuses. The patient was reassured that she was suffering from acute sinusitis which should resolve itself in 2-3 weeks without antibiotic therapy.
She now has a frontal headache with nausea. She is also having increasing difficulty lifting her right arm and leg. She presents herself to the emergency department with these new symptoms, whilst in the department, she has a seizure.
Which complication of acute sinusitis has she developed?

A

Cerebral Abscess

41
Q

In the UK, what is the most causative organism in an adult affected by encephalitis?

A

Herpes Simplex Virus

42
Q

Which of the following drugs are used in the management of Myasthenia Gravis? (2)

A

Pyridostigmine

Prednisolone

43
Q

Tests for Myasthenia Gravis (5)

A
  • CT Thorax
  • Acetylcholine Receptor Antibody
  • Anti Muscle Specific Tyrosine Kinase Antibody
  • EMG
  • Creatinine Kinase
44
Q

A 40 year old female presents with tiredness that she says is worse in the evenings and better in the mornings when we wake up. She works as a cleaner in a local highschool and has recently had to take time off because she is so tired by the end of each shift. On examination you notice ptosis and her speech becoming slurred towards the end of the consultation.
What is the most likely diagnosis?

A

Myasthenia Gravis

45
Q

Classify Myasthenia Gravis based on site of lesion?

A

Neuromuscular Junction

46
Q

Classify General Peripheral Neuropathy based on site of lesion?

A

Sensory and Motor

47
Q

Classify Guillian Barre Syndrome based on site of lesion?

A

Sensory and Motor

48
Q

Classify Motor Neurone Disease based on site of lesion?

A

UMN and LMN

49
Q

A 65 year old man with a history of prostate cancer presents to his GP with back pain. It has been bothering him for a couple of months now. He is concerned that his prostate cancer has come back and read on the internet that it can spread to your spine. Which of the following features of back pain would you consider as alarming? (3)

A

Pain on lying down supine

Thoracic Pain

Weight Loss

50
Q

A 59 year old man has presented to the GP with a 6 month history of neck and back pain. The pain is described as being like ‘electric shocks’ and is worse when he turns his head. There is no history of trauma and no other obvious trigger. He has no chronic conditions and is not taking any medications. On examination he has decreased sensation on the dorsal aspect of the thumb and index finger.
What is the most likely underlying diagnosis?

A

C6 Radiculopathy

51
Q

A 82-year old woman presents with a 2 day history of neck pain, paraesthesia in her fingers and progressive leg weakness. Which of the following investigations is the gold standard for diagnosing degenerative cervical myelopathy?

A

MRI Cervical Spine

52
Q

A 45-year-old woman is admitted to the emergency department following a stabbing incident. She has multiple wounds on her flank and lower back that the medics suspect were caused by a knife.
You perform a full neurological examination which reveals the following:
• weakness in extension and flexion of the right knee
• loss of proprioception and vibration below mid thigh in the right leg
• loss of pain sensation below the mid thigh in left leg

Given the likely diagnosis, which of the following best describes the damage to the spinal cord sustained?

A

Brown Squared Syndrome: Right lateral hemisection of cord damaged

53
Q

A 31-year-old intravenous drug user is brought to the emergency department with back pain, bilateral leg weakness and fever. What is the most likely diagnosis?

A

Epidural Abscess

54
Q

An 82 year old man presents with back pain. This pain is typically worse lying down. He has noticed he has been more unsteady on his feet recently. He has a past medical history of prostate cancer which he is currency taking hormonal therapies for. Given the likely diagnosis what is the first line management?

A

Oral Dexamethasone

55
Q

A 31-year-old intravenous drug user is brought to the emergency department with back pain, bilateral leg weakness and fever. What is the most likely diagnosis?

A

Epidural Abscess

56
Q 
A patient presents sudden onset of bilateral leg weakness, bladder dysfunction and saddle anesthesia. Given the likely diagnosis what other signs may you elicit that would be in keeping with the diagnosis? (tick all that apply)
Select one or more:
a. Loss of sensation over L5 dermatome
b. Clonus
c. Hypotonia 
d. Hyporeflexia
e. Hyperreflexia
A

Hyporeflexia, Hypotonia, Loss of sensation over L5 dermatome

57
Q

What are the clinical exam findings in a patient with an upper motor neuron lesion (4)

A

Hyperreflexia, Positive babinski test, Hypertonia, Clonus present

58
Q

A 34 year old lady is admitted with visual disturbance. On examination she is noted to have mydriasis and diminished direct response to light shone into the affected left eye. The consensual response in the affected eye is preserved. She also experiences pain in her left eye that comes on with movement. Her right eye is completely normal. She remembers that last year she developed some paresthesia in her left foot that resolved after a few weeks. She did not seek medical advice at the time.
What is the most likely cranial nerve responsible for the eye symptoms?

Select one:

a. abducens nerve
b. Oculomotor nerve
c. Optic Nerve
d. Trochlear nerve
e. Trigeminal nerve

A

Optic Nerve

59
Q

Infective Causes of Facial Nerve Palsy? (5)

A 
Otitis Media
Malignant Otitis Externa
HIV
Lyme's Disease
Herpes Zoster (Ramsay Hunt)
60
Q

Systemic Causes of Facial Nerve Palsy? (5)

A 
Diabetes
Sarcoidosis
Leukaemia
MS
Guillan Barre
61
Q

Tumour causes of Facial Nerve Palsy? (3)

A

Acoustic Neuroma
Parotid Tumours
Cholesteatoma

62
Q

A 70-year old woman presents to the Emergency Department by ambulance. She had a severe headache and nausea then had a subsequent epileptic fit. Fundoscopy shows papilloedema. She complains of diplopia when asked to look laterally.
What is the most likely cranial nerve responsible for the symptoms?

A

Abducens Nerve

63
Q

A 70-year old woman presents to the Emergency Department by ambulance. She had a severe headache and nausea then had a subsequent epileptic fit. Fundoscopy shows papilloedema. She complains of diplopia when asked to look laterally.
What is the most likely cranial nerve responsible for the symptoms?

A

Vestibular Neuronitis

64
Q

A 22 year old patient presents to an emergency appointment with a 4-day history of pain behind her right ear. She has woken up today with a facial paralysis. You notice her mouth is drooping downwards on the right and she cannot completely close her right eye. Given the most likely diagnosis is Bell’s Palsy, what finding would you expect if you asked the patient to raise her right eyebrow and why?

A

Inability to raise the left eyebrow as Bell’s palsy is due to a lower motor neuron lesion

65
Q

You want to examine Mr Smith’s cranial nerves as he has to come to see you today complaining of double vision. Whilst looking forward his left eye turns adducted. When you ask him to look to his right there is no obvious squint. But when he looks toward his left he is unable to abduct the left eye and double vision worsens. What is the most likely underlying problem?

Select one:

a. Right 4th nerve palsy
b. Right 3rd nerve palsy
c. Left 6th nerve palsy
d. Right 6th nerve palsy
e. Left 3rd nerve palsy

A

Left 6th Nerve Palsy

66
Q

What cranial nerve has a special visceral component that is responsible for taste to the posterior ⅓ of the tongue?

A

Glossopharyngeal Nerve

67
Q

Which cranial nerve supplies the Inferior oblique muscle of the eye?

A

Occulomotor Nerve

68
Q

What cranial nerves emerge from the pontomedullary junction? (3)

A

Abducens Nerve
Facial Nerve
Vestibulochelar Nerve

69
Q

A 65 year old gentleman has presented with left hemiparesis and sensory loss that came on suddenly 3 hours ago. A CT head is ordered. It is confirmed that he has a right sided infarction. There is no evidence of haemorrhage. Before proceeding with his management, what clue in the history would mean that thrombolysis is not an option for this gentleman’s treatment (2)

A

Lumbar Puncture

Uncontrolled Hypertension

70
Q

A 68-year-old woman comes in with a headache, blurred vision and sleepiness. She is recovering alcoholic and has a past medical history of falls. Examination reveals papilloedema and other than a GCS of 12. On CT a crescent shaped haemorrhage is identified that is not limited by the cranial sutures.
Given the most likely diagnosis what damaged vessel(s) describes these signs and symptoms?

A

Bridging Veins

71
Q

A 57-year-old female attends the emergency department with a sudden onset of a severe occipital headache and has vomited 3 times in the past hour. An urgent CT scan finds no abnormalities, however, a lumbar puncture taken 12 hours later is positive for xanthochromia
What is the most likely diagnosis?

A

Subarachnoid Haemorrhage

72
Q

A 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?

A

Coiling

73
Q

A 71 year old man has progressive loss of short term memory. He has been experiencing visual hallucinations and is embarrassed to admit this. While the GP is talking to him she realises his right hand has a resting tremor

A

Lewy body Dementia

74
Q

Jim is 57year old man who has come to the GP with his husband. His husband has noticed that Jim has been more aggressive and is exhibiting inappropriate behaviours when they are out in public. As the GP you ask about memory loss and there is no mention of any impairment. They are both worried about the gradual change in personality

A

Fronto-Temporal Dementia

75
Q

Margaret is a 78 year old woman who has presented to the GP with some concerns about her memory. Her husband has come with her today and he says that over the last 3 years she has had some sudden deteriorations, where he has noticed she has got considerably worse in a short period of time. BUt then she stays stable after these drops. She has a history of difficulty controlling her hypertension.

A

Vascular Dementia

76
Q

A 85 year old man comes to the GP with a 12 month history of gradual decline in memory. His daughter has urged him to come to the doctor to get checked over as he is forgetting appointments, and even how to do some simple tasks that he has done his whole life eg. cooking his famous macaroni

A

Alzheimers

77
Q

Which of the following is the most common primary tumour in adults?

A

Glioblastoma multiforme

78
Q

Which of the following primary cancers does not commonly metastasise to the brain?

A

Pancreatic

79
Q

Which of the following is the most common malignant tumour in children?

A

Medullablastoma

80
Q

Which type of herniation syndrome is most worrying as it can cause cardiovascular and respiratory compromise?

A

Tonsilar

81
Q

In uncal herniation (transtentorial herniation) which concerning clinical sign may be elicited on examination?

A

Down and out position of the ipsilateral

82
Q

Which of the following would you NOT test for in a test for brain stem death? (2)

A

Patellar tendon reflex, Babinski’s reflex

Year 3 Exams: Neurology (1 decks)

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