SBA Qs Flashcards
A 35Y F presents to A&E complaining of progressive leg weakness, and swallowing difficulties. Maximal expiratory pressure was 68% of normal. PMHx reveals previous admission for treatment of gastroenteritis caused by Campylobacter jejuni two weeks ago. On examination she has hyporeflexia, bilateral facial drooping and is in urinary retention.
What is your immediate management for this patient?
A. Administer IV Immunoglobulins
B. Admit to ITU for mechanical ventilation
C. 40mg Prednisolone
D. Keep a watchful eye and wait
E. Give Dalteparin for thromboprophylaxis
B. Admit to ITU for mechanical ventilation
Guillain-Barre syndrome is an immune-mediated polyneuropathy that cases rapid demyelination of the peripheral NS. It is associated with recent infection usually by Campylobacter jejuni. It is usually ascending.
IVIG is first line. However, admit to ITU if signs of bulbar dysfunction, i.e. if cranial nerves 9-12 are affected. Patients will require mechanical ventilation in the ITU. Also admit to ITU if respiration is poor, especially if maximal expiratory pressure is reduced by 30% of more. IVIG is then administered after.
A 21F presents complaining of recurring headaches which she describes to be throbbing in nature and only on one side. She complains that the headache gets worse when she is using her phone to watch videos. She also complains of seeing floating shapes before her headache presents. Her PMHx includes bipolar disorder, asthma, eczema, allergic rhinitis and PCOS. She is taking lithium, the oral contraceptive pill, loratadine and has a salbutamol inhaler.
Which medication(s) should be stopped?
A. Salbutamol inhaler
B. Loratadine
C. The oral contraceptive pill
D. Lithium and loratadine
E. Lithium and salbutamol inhaler
C. The oral contraceptive pill
Migraine with aura. Prescribe triptans for migraine and beta-blockers for prophylactic effect. OCP is contraindicated in those with migraines due to significant increased risk of stroke so this should be stopped
A 13-month baby presents to A&E with a distressed mother complaining that her baby just doesn’t seem himself. He seems drowsy and has fluctuating levels of alertness. On examination you notice the baby has multiple unexplained bruises on his body and is very small for his age. You then order a CT head.
What signs will you see on the CT head?
A. Crescent shaped haematoma indicating extradural haemorrhage
B. Crescent shaped haematoma indicating subdural haemorrhage
C. Star shaped haematoma indicating extradural haemorrhage
D. Lens shaped haematoma indicating a subdural haemorrhage
E. Lens shaped haematoma indicating a subarachnoid haemorrhage
B. Crescent shaped haematoma indicating subdural haemorrhage
Suspected shaken baby syndrome - baby shaken vigorously causing bleed in subdural space. Can happen if parents are abusive and neglectful. Presents with fluctuating levels of consiousness, drowsiness, headache, signs of raised ICP - N+V, confusion, etc. Subdural haematoma common due to small brain size, so bridging veins are vulnerable and prone to rupture. CT shows a bleed in subdural space that looks like a crescent.
An 85M presents to A&E with unilateral hemiparesis and hemiplegia. He has trouble speaking and is unable to understand you. His wife explains that this has been going on for the last 5 hours and his first symptom was slurring of speech. You request an urgent CT which shows areas of infarction and administer 300mg Aspirin.
What treatment would then be offered?
A. IV Alteplase
B. Perform thrombectomy
C. Clopidogrel
D. Atorvastatin
E. Request MRI
B. Perform thrombectomy
Acute ischaemic stroke confirmed by CT scan. As they have been experiencing symptoms for longer than 4.5 hours, no longer eligible for thrombolysis treatment (IV alteplase). Offer thrombectomy if within 6 hours once the stroke has been confirmed with CT or within 24 hours if imagining shows salvageable tissue.
A 26M presents with headache, neck pain, fever and a non-blanching purpuric rash covering his trunk and arms. You suspect bacterial meningitis and perform a lumbar puncture to confirm your diagnosis. What findings do you expect to see on the results?
A. Clear fluid, low protein, elevated glucose
B. Turbid fluid, raised WCC, low glucose
C. Turbid fluid, normal WCC, low glucose
D. Clear fluid, raised WCC, normal glucose
E. Clear fluid, low WCC, normal glucose
B. Turbid fluid, raised WCC, low glucose
A 26 year old woman presents to you with cloudy vision (blurry and difficulty seeing the colour red) in one eye and pain upon movement of that eye. She smokes a pack a day and has done this for the past 10 years. She states that she has had similar episodes previously but they usually self resolve. However, this time it has lasted a few days and she also has some leg weakness which she noticed after taking a shower.What is your diagnosis?
A. Multiple sclerosis
B. Guillain-barre
C. Myasthenia gravis
D. Glioblastoma multiforme
E. Stroke
A. Multiple sclerosis
An 18-year-old girl presents with several episodes of confusion over the past several months. These episodes start with a rising sensation within her abdomen that travels upward through her chest. She is usually unaware for a few minutes, but others have told her that during these episodes she smacks her lips, picks at her clothing, and is unable to speak.
After the event, she feels tired, has a headache, and prefers to lie down.
Her medical history is notable for several febrile seizures as a young child, although she was not treated for seizures at that time. She takes the oral contraceptive pill.
What would be the most appropriate treatment?
A. Sodium valproate
B. Diazepam
C. Lamotrigine
D. Carbamazepine
E. Reassure and educate patient
C. Lamotrigine
Focal seizure
A 63-year-old caucasian woman presents with partial vision loss in the right eye.
She reports bitemporal headache for several weeks which is made worse by chewing, accompanied by pain and stiffness in the neck and shoulders.
Review of systems is positive for low-grade fever, fatigue, and weight loss. She states that sometimes she loses complete vision in an eye for a brief moment and describes it like a curtain drawing over her eyes.
What would be the most appropriate immediate management?
A. Prednisone
B. Oxygen
C. Paracetamol
D. Aspirin
E. Methylprednisolone IV
E. Methylprednisolone IV
Temporal arteritis. High dose steroids: oral prednisolone if no visual symptoms and IV methylprednisolone if visual symptoms.
A 60-year-old man presents with right foot drop, which has developed gradually over the last year and progressed to involve more proximal areas in the last 2 months. The patient reports associated muscle twitching and painful muscle cramps involving the same areas. The neurologic examination reveals bilateral lower-extremity weakness, more severe on the right, with associated spasticity, atrophy of the right foot intrinsic muscles, diffuse fasciculations, and hyperreflexia, with deep tendon reflexes being brisker on the right lower extremity, and a positive right Babinski sign. Sensation is preserved throughout. Several other family members have been diagnosed (some have died) with a pattern suggesting autosomal dominant disease.
What would you give for management?
A. Riluzole
B. Oral pyridostigmine
C. IV immunoglobulin
D. L-dopa
E. IV alemtuzumab
A. Riluzole
Amyotrophic lateral sclerosis (ALS). Ant glutamatergic drugs - oral riluzole (Na channel blocker that inhibits glutamate release).
A 22 woman presents with recurrent slurring of speech that worsens when she continues to talk. She has trouble swallowing which also gets worse. She reports that during work her eyelid start to feel heavy after staring at the screen and her double vision gets worse. Her symptoms have deteriorated over the past few months. She has intermittent weakness in her legs and arm. She reports a feeling of generalized fatigue and is short of breath. She finds that she usually feels slightly better after waking up.
What antibody is linked with this condition?
A. Anti-EMA
B. Anti-CCP
C. Antinuclear antibody
D. Anti-musk / anti-AChR
E. Anti peritoneal antibody
D. Anti-musk / anti-AChR
Myasthenia gravis. Autoimmune disease against acetylcholine receptors of the neuromuscular junction.
A 64 year old white male presents to emergency services unconscious. You ask his wife and she describes him having an excruciating headache while reading his evening news. Upon further questioning she states it was preceded by him having a painful headache in the morning. She states he has a past medical history of hypertension, polycystic kidney disease. He has a 15 year pack history and drinks every weekend. A CT is done and it confirms a Subarachnoid haemorrhage.
What would be your initial management ?
A. Mannitol
B. IV alteplase
C. Nimodipine
D. Burrhole surgery
E. Endovascular coiling
C. Nimodipine
Subarachnoid haemorrhage. Cardiopulmonary support and discontinue any antiplatelet and anticoagulant, nimodipine to prevent further vasospasms and reduce ischaemia and then surgical management.
A 20 y/o boy presents to clinic complaining of a ‘dead foot’. He tells you his right foot has been like this since he woke up after an adventurous night out at Tank and falling asleep on the floor cross-legged.
On further examination, you discover that his right foot also has weak ankle eversion and sensory loss over the dorsum of the foot.
Given the likely diagnosis, which of the following structures do you think has been affected?
A. Uncommon fibular nerve
B. Sciatic nerve
C. Common peroneal nerve
D. Sural nerve
E. Lateral sural nerve
C. Common peroneal nerve
Foot drop. Falling asleep cross-legged can cause damage to the common peroneal nerve which wraps around the fibular head.
A 57 year old female patient comes into clinic complaining of numbness in her left hand, especially at night. She often has to shake it off to relieve it. Alongside this, she often feels tingling and numbness in her hands. The doctor then asks the patient to flex their wrists to 90 degrees and to hold it in that position for at least 30 seconds. The patient complains of numbness and tingling throughout. What was the test performed?
A. Tinel’s test
B. Chvostek’s test
C. Mcmurray’s test
D. Brudzinski’s test
E. Phalen’s test
E. Phalen’s test
Carpal tunnel syndrome. Tinel’s test is tapping.
A 52 year old male patient goes to his GP complaining of a headache, nausea and vomiting. The headache has been going on for a couple of months and seems to be getting worse over time. The GP orders an MRI scan, and finds a mass in the patient’s brain. What is the most likely cause?
A. Metastasis from lung cancer
B. Glioblastoma multiforme
C. Meningioma
D. Metastasis from breast cancer
E. Pilocytic astrocytoma
A. Metastasis from lung cancer
Brain tumour most commonly a result of metastatic spread, rather than being a primary lesion. Most commonly from lung, breast, bowel, skin and kidney cancer.
Describe Brudzinski’s and Kernig’s sign
Kernig: knee and hip flexed to 90 and extension of knee is painful or limited
Brudzinski: passive flexion of neck elicits hip and knee flexion
