00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - For which condition is the Mini-Mental State Examination (MMSE) a screening questionnaire? ...

    Incorrect

    • For which condition is the Mini-Mental State Examination (MMSE) a screening questionnaire?

      Your Answer: Alzheimer’s dementia

      Correct Answer: Cognitive impairment

      Explanation:

      The MMSE as a Screening Tool for Cognitive Impairment and Dementia

      The Mini-Mental State Examination (MMSE) is a widely used screening tool for cognitive impairment and dementia. It assesses cognitive functioning and gives a score out of 30, which can be used to identify individuals who may require further investigation for dementia. However, the MMSE is sensitive to education, and individuals with limited education may have lower scores without cognitive impairment.

      While the MMSE is a valuable screening tool for moderate and severe dementia, it cannot make a diagnosis of any type of dementia on its own. It detects cognitive impairment, not cognitive decline, which requires a history. Additionally, there is no reliable test that assesses mental illnesses as a whole.

      Nevertheless, the MMSE has been used in many community studies of older people and has proved to be a valuable screening tool for various types of dementia, including vascular dementia. Overall, the MMSE is a useful tool for identifying cognitive impairment and potential dementia, but it should be used in conjunction with other assessments and evaluations.

    • This question is part of the following fields:

      • Neurology
      6.7
      Seconds
  • Question 2 - A 65-year-old man, who was recently diagnosed with atrial fibrillation but has not...

    Correct

    • A 65-year-old man, who was recently diagnosed with atrial fibrillation but has not yet started any anticoagulant medication, presents with new-onset weakness on the left side of his body. He is also experiencing difficulty speaking and has lost vision on the left side. He contacts emergency services and is transported to the hospital where he undergoes an urgent CT head and MR angiogram. The results confirm a proximal anterior circulation occlusive stroke that occurred approximately 3 hours ago.

      What is the most definitive course of action for managing this patient?

      Your Answer: Arrange thrombectomy AND thrombolysis as soon as possible

      Explanation:

      For patients with an acute ischaemic stroke who present within 4.5 hours, it is recommended to arrange both thrombolysis and thrombectomy as soon as possible. This is in line with NICE guidelines, which suggest offering both treatments to patients diagnosed with an acute proximal anterior circulation occlusive stroke confirmed on CT or MR angiogram. Thrombectomy alone can be offered up to 6 hours post-presentation. Giving a stat dose of aspirin is also part of the acute treatment of ischaemic stroke, but it is not a definitive treatment option. Starting apixaban for atrial fibrillation is not appropriate in the initial management of acute ischaemic stroke, as anticoagulant treatment is usually delayed for at least 2 weeks to reduce the risk of haemorrhagic transformation.

      The Royal College of Physicians (RCP) and NICE have published guidelines on the diagnosis and management of patients following a stroke. The management of acute stroke includes maintaining normal levels of blood glucose, hydration, oxygen saturation, and temperature. Blood pressure should not be lowered in the acute phase unless there are complications. Aspirin should be given as soon as possible if a haemorrhagic stroke has been excluded. Anticoagulants should not be started until brain imaging has excluded haemorrhage. Thrombolysis with alteplase should only be given if administered within 4.5 hours of onset of stroke symptoms and haemorrhage has been definitively excluded. Mechanical thrombectomy is a new treatment option for patients with an acute ischaemic stroke. NICE recommends thrombectomy for people who have acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography or magnetic resonance angiography. Secondary prevention includes the use of clopidogrel and dipyridamole. Carotid artery endarterectomy should only be considered if carotid stenosis is greater than 70% according to ECST criteria or greater than 50% according to NASCET criteria.

    • This question is part of the following fields:

      • Neurology
      39.1
      Seconds
  • Question 3 - A 28-year-old woman is referred to the Neurology Clinic with suspected Guillain–Barré syndrome...

    Correct

    • A 28-year-old woman is referred to the Neurology Clinic with suspected Guillain–Barré syndrome (GBS). A lumbar puncture (LP) is performed on the patient to rule out any other causes. The results of the LP show normal white blood cells (WBCs) and elevated proteins.
      What immediate management should be started for this patient?
      Select the SINGLE most appropriate management from the list below.

      Your Answer: Intravenous immunoglobulins

      Explanation:

      Guillain-Barré syndrome (GBS) can be treated with either plasma exchange or intravenous immunoglobulin (IVIG), both of which are equally effective. The decision on which treatment to use depends on the institution. Plasma exchange is recommended for ambulatory patients within two weeks of symptom onset and for non-ambulatory patients within four weeks. It is most effective when started within seven days of symptom onset, but improvement can still be seen up to 30 days after onset. Patients receiving plasma exchange should be closely monitored for electrolyte abnormalities and coagulopathies, as well as complications such as infection, blood pressure instability, cardiac arrhythmias, and pulmonary embolus. Compared to IVIG, plasma exchange has a higher risk of pneumonia, atelectasis, thrombosis, and hemodynamic difficulties. Urgent referral to oncology is appropriate if the patient has signs of metastatic spinal cord compression. High-dose dexamethasone is not indicated in this case as there is no history of cancer. Intravenous ceftriaxone is used to treat meningitis, which was ruled out by the LP findings. Intravenous itraconazole would be appropriate if fungal meningitis were suspected based on the patient’s history and LP results.

    • This question is part of the following fields:

      • Neurology
      27.3
      Seconds
  • Question 4 - An 82-year-old woman is diagnosed with Alzheimer’s disease and the next appropriate step...

    Correct

    • An 82-year-old woman is diagnosed with Alzheimer’s disease and the next appropriate step is likely starting her on donepezil. She has a past medical history of ischaemic heart diseases, pacemaker insertion for bradyarrhythmias, diabetes mellitus type II, hypercholesterolaemia and general anxiety disorder (GAD).
      Which one of the following could be a contraindication to the prescription of donepezil?

      Your Answer: Bradycardia

      Explanation:

      Contraindications and Considerations for the Use of Donepezil

      Donepezil is a medication used to treat Alzheimer’s disease. However, there are certain contraindications and considerations that healthcare professionals should keep in mind when prescribing this medication.

      Bradycardia, a condition where the heart beats too slowly, is a relative contraindication for the use of donepezil. This medication may cause bradycardia and atrioventricular node block, so caution should be taken in patients with other cardiac abnormalities. Additionally, patients with asthma, chronic obstructive pulmonary disease, supraventricular conduction abnormalities, susceptibility to peptic ulcers, and sick-sinus syndrome should also be closely monitored when taking donepezil.

      Concurrent use of simvastatin, a medication used to lower cholesterol levels, is not a concern when taking donepezil. General anxiety disorder (GAD) and diabetes mellitus type II are also not contraindications for the use of donepezil.

      However, elderly patients with a known history of persistent bradycardia, heart block, recurrent unexplained syncope, or concurrent treatment with drugs that reduce heart rate should avoid donepezil. A history of ischaemic heart diseases alone is not a contraindication for donepezil.

      In summary, healthcare professionals should carefully consider a patient’s medical history and current medications before prescribing donepezil. Close monitoring is necessary in patients with certain cardiac abnormalities and caution should be taken in elderly patients with a history of bradycardia or heart block.

    • This question is part of the following fields:

      • Neurology
      9.4
      Seconds
  • Question 5 - A 25-year-old male comes to the neurology department with complaints of weakness. He...

    Correct

    • A 25-year-old male comes to the neurology department with complaints of weakness. He initially experienced weakness in his legs a few days ago, which has now progressed to involve his arms. Additionally, he is experiencing shooting pains in his back and limbs. About four weeks ago, he had a brief episode of vomiting and diarrhea. Upon examination, reduced tendon reflexes and weakness are confirmed.

      What test results would you anticipate for this patient?

      Your Answer: Abnormal nerve conduction studies

      Explanation:

      Guillain-Barre syndrome can be diagnosed with the help of nerve conduction studies. The presence of ascending weakness after an infection is a common symptom of this syndrome. Most patients with Guillain-Barre syndrome show abnormal nerve conduction study results. If there are cord signal changes, it may indicate spinal cord compression or a spinal lesion. Inflammatory infiltrates on muscle biopsy are typically observed in patients with myositis. Myasthenia gravis is characterized by the presence of anti-acetylcholine receptor antibodies. In Guillain-Barre syndrome, the CSF protein level is usually elevated, not decreased.

      Understanding Guillain-Barre Syndrome: Symptoms and Features

      Guillain-Barre syndrome is a condition that affects the peripheral nervous system and is caused by an immune-mediated demyelination. It is often triggered by an infection, with Campylobacter jejuni being a common culprit. The initial symptoms of the illness include back and leg pain, which is experienced by around 65% of patients. The characteristic feature of Guillain-Barre syndrome is a progressive, symmetrical weakness of all the limbs, with the weakness typically starting in the legs and ascending upwards. Reflexes are reduced or absent, and sensory symptoms tend to be mild, with very few sensory signs.

      Other features of Guillain-Barre syndrome may include a history of gastroenteritis, respiratory muscle weakness, cranial nerve involvement, diplopia, bilateral facial nerve palsy, oropharyngeal weakness, and autonomic involvement. Autonomic involvement may manifest as urinary retention or diarrhea. Less common findings may include papilloedema, which is thought to be secondary to reduced CSF resorption.

      To diagnose Guillain-Barre syndrome, a lumbar puncture may be performed, which can reveal a rise in protein with a normal white blood cell count (albuminocytologic dissociation) in 66% of cases. Nerve conduction studies may also be conducted, which can show decreased motor nerve conduction velocity due to demyelination, prolonged distal motor latency, and increased F wave latency. Understanding the symptoms and features of Guillain-Barre syndrome is crucial for prompt diagnosis and treatment.

    • This question is part of the following fields:

      • Neurology
      23229.3
      Seconds
  • Question 6 - A 20 year-old female patient visits her GP to request a refill of...

    Correct

    • A 20 year-old female patient visits her GP to request a refill of her COCP prescription. She reports experiencing intense headaches on the left side of her head, accompanied by visual disturbances prior to the onset of the headache. Upon examination, no abnormalities are detected. What is the best course of action for managing her symptoms?

      Your Answer: Stop the COCP and start treatment on a progesterone only contraceptive pill.

      Explanation:

      The woman is experiencing migraines with aura, a condition that can be exacerbated by the use of COCP. If a woman has migraine with aura, it is recommended that she discontinue the use of the pill immediately. This is because the oestrogen component of COCP can increase the risk of ischaemic stroke. The only alternative contraceptive medication that can be prescribed is a progesterone-only contraceptive pill, as other options contain oestrogen.

      Counselling for Women Considering the Combined Oral Contraceptive Pill

      Women who are considering taking the combined oral contraceptive pill (COC) should receive counselling on the potential harms and benefits of the pill. The COC is highly effective if taken correctly, with a success rate of over 99%. However, there is a small risk of blood clots, heart attacks, and strokes, as well as an increased risk of breast and cervical cancer.

      In addition to discussing the potential risks and benefits, women should also receive advice on how to take the pill. If the COC is started within the first 5 days of the menstrual cycle, there is no need for additional contraception. However, if it is started at any other point in the cycle, alternative contraception should be used for the first 7 days. Women should take the pill at the same time every day and should be aware that intercourse during the pill-free period is only safe if the next pack is started on time.

      There have been recent changes to the guidelines for taking the COC. While it was previously recommended to take the pill for 21 days and then stop for 7 days to mimic menstruation, it is now recommended to discuss tailored regimes with women. This is because there is no medical benefit to having a withdrawal bleed, and options include never having a pill-free interval or taking three 21-day packs back-to-back before having a 4 or 7 day break.

      Women should also be informed of situations where the efficacy of the pill may be reduced, such as vomiting within 2 hours of taking the pill, medication that induces diarrhoea or vomiting, or taking liver enzyme-inducing drugs. It is also important to discuss sexually transmitted infections and precautions that should be taken with enzyme-inducing antibiotics such as rifampicin.

      Overall, counselling for women considering the COC should cover a range of topics to ensure that they are fully informed and able to make an informed decision about their contraceptive options.

    • This question is part of the following fields:

      • Neurology
      34
      Seconds
  • Question 7 - An older gentleman patient presents with arthritic pains. At the end of the...

    Correct

    • An older gentleman patient presents with arthritic pains. At the end of the consultation, he mentions that he recently visited a doctor at the memory clinic who diagnosed him with Alzheimer's dementia. However, he cannot recall why he was not prescribed any medication for this condition.

      Which of the following factors would be a potential relative contraindication to prescribing donepezil for this patient?

      Your Answer: Resting bradycardia

      Explanation:

      Managing Alzheimer’s Disease: Non-Pharmacological and Pharmacological Approaches

      Alzheimer’s disease is a type of dementia that progressively affects the brain and is the most common form of dementia in the UK. To manage this condition, there are both non-pharmacological and pharmacological approaches available.

      Non-pharmacological management involves offering a range of activities that promote wellbeing and are tailored to the patient’s preferences. Group cognitive stimulation therapy is recommended for patients with mild to moderate dementia, while group reminiscence therapy and cognitive rehabilitation are also options to consider.

      Pharmacological management involves the use of medications. The three acetylcholinesterase inhibitors (donepezil, galantamine, and rivastigmine) are options for managing mild to moderate Alzheimer’s disease. Memantine, an NMDA receptor antagonist, is considered a second-line treatment and is recommended for patients with moderate Alzheimer’s who are intolerant of or have a contraindication to acetylcholinesterase inhibitors. It can also be used as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s or as monotherapy in severe Alzheimer’s.

      When managing non-cognitive symptoms, NICE does not recommend antidepressants for mild to moderate depression in patients with dementia. Antipsychotics should only be used for patients at risk of harming themselves or others or when the agitation, hallucinations, or delusions are causing them severe distress.

      It is important to note that donepezil is relatively contraindicated in patients with bradycardia, and adverse effects may include insomnia. By utilizing both non-pharmacological and pharmacological approaches, patients with Alzheimer’s disease can receive comprehensive care and management.

    • This question is part of the following fields:

      • Neurology
      114
      Seconds
  • Question 8 - A 14-year-old boy presents with difficulty in walking and foot drop. There is...

    Correct

    • A 14-year-old boy presents with difficulty in walking and foot drop. There is weakness of dorsiflexion and eversion of the right foot, with a small area of sensory loss over the dorsum of that foot.
      Which of the following is the most likely diagnosis?

      Your Answer: Common peroneal nerve lesion

      Explanation:

      The common peroneal nerve is a branch of the sciatic nerve that provides motor and sensory innervation to the lateral and anterior compartments of the leg, as well as the dorsum of the foot. Damage to this nerve, often caused by fibular neck fracture, results in footdrop and sensory loss in the affected areas.

      The sciatic nerve, which originates from the lumbosacral plexus, innervates the posterior compartment of the thigh and indirectly innervates the posterior leg/calf muscles and some intrinsic muscles of the feet. It also provides sensory innervation to the posterolateral leg, lateral foot, and sole of the foot. Sciatica, a common condition that causes pain radiating down the leg, is often caused by irritation of the sciatic nerve root.

      The posterior tibial nerve, another branch of the sciatic nerve, supplies motor innervation to the posterior compartment of the leg and sensory innervation to the posterolateral leg, lateral foot, and sole of the foot. Damage to this nerve, often caused by compression or trauma, results in ankle and sole of foot paraesthesiae.

      The L5 root innervates muscles responsible for ankle and great toe dorsiflexion, hip abduction, and sensory innervation to the buttocks, posterolateral thigh, and lateral calf. L5 radiculopathy, which causes pain radiating from the lower back to the foot, is a common condition associated with damage to this root.

      The deep peroneal nerve, a branch of the common peroneal nerve, innervates the muscles responsible for foot dorsiflexion and provides sensory innervation to the area between the first and second toes. Damage to this nerve, often caused by conditions such as LMD or diabetes, results in footdrop with minimal sensory loss and preserved eversion.

    • This question is part of the following fields:

      • Neurology
      8.6
      Seconds
  • Question 9 - An 80-year-old woman is brought to the emergency department by ambulance due to...

    Correct

    • An 80-year-old woman is brought to the emergency department by ambulance due to right-sided limb weakness, facial droop, and slurred speech. A CT head scan shows a left-sided infarct but no haemorrhage. Her admission ECG reveals new atrial fibrillation (AF). Aspirin 300mg is given for the acute stroke, and she is recovering well on the ward. After two weeks, what medication should be initiated to lower the risk of future strokes?

      Your Answer: Warfarin or a direct thrombin or factor Xa inhibitor

      Explanation:

      For patients with AF who have experienced a stroke or TIA, the recommended anticoagulant is warfarin or a direct thrombin or factor Xa inhibitor. Aspirin/dipyridamole should only be used if necessary for the treatment of other conditions, which is not the case in this scenario. Clopidogrel is typically prescribed for TIA patients without AF, but in this case, the patient had a stroke and would require long-term treatment with a different medication.

      Managing Atrial Fibrillation Post-Stroke

      Atrial fibrillation is a significant risk factor for ischaemic stroke, making it crucial to identify and treat the condition in patients who have suffered a stroke or transient ischaemic attack (TIA). However, before starting any anticoagulation or antiplatelet therapy, it is important to rule out haemorrhage. For long-term stroke prevention, NICE Clinical Knowledge Summaries recommend warfarin or a direct thrombin or factor Xa inhibitor. The timing of when to start treatment depends on whether it is a TIA or stroke. In the case of a TIA, anticoagulation for AF should begin immediately after imaging has excluded haemorrhage. For acute stroke patients, anticoagulation therapy should be initiated after two weeks in the absence of haemorrhage. Antiplatelet therapy should be given during the intervening period. However, if imaging shows a very large cerebral infarction, the initiation of anticoagulation should be delayed.

      Overall, managing atrial fibrillation post-stroke requires careful consideration of the patient’s individual circumstances and imaging results. By following these guidelines, healthcare professionals can help prevent future strokes and improve patient outcomes.

    • This question is part of the following fields:

      • Neurology
      111.9
      Seconds
  • Question 10 - A client is observed to have a missing biceps reflex. To which nerve...

    Correct

    • A client is observed to have a missing biceps reflex. To which nerve root does this correspond?

      Your Answer: C5-C6

      Explanation:

      Understanding Common Reflexes

      Reflexes are automatic responses of the body to certain stimuli. These responses are controlled by the nervous system and do not require conscious thought. Common reflexes include the ankle reflex, knee reflex, biceps reflex, and triceps reflex. Each reflex is associated with a specific root in the spinal cord.

      The ankle reflex is associated with the S1-S2 root, which is located in the lower part of the spinal cord. This reflex is elicited by tapping the Achilles tendon with a reflex hammer. The resulting contraction of the calf muscle indicates the integrity of the spinal cord and the peripheral nerves.

      The knee reflex is associated with the L3-L4 root, which is located in the middle part of the spinal cord. This reflex is elicited by tapping the patellar tendon with a reflex hammer. The resulting contraction of the quadriceps muscle indicates the integrity of the spinal cord and the peripheral nerves.

      The biceps reflex is associated with the C5-C6 root, which is located in the upper part of the spinal cord. This reflex is elicited by tapping the biceps tendon with a reflex hammer. The resulting contraction of the biceps muscle indicates the integrity of the spinal cord and the peripheral nerves.

      The triceps reflex is associated with the C7-C8 root, which is located in the upper part of the spinal cord. This reflex is elicited by tapping the triceps tendon with a reflex hammer. The resulting contraction of the triceps muscle indicates the integrity of the spinal cord and the peripheral nerves.

      Understanding these common reflexes can help healthcare professionals diagnose and treat various neurological conditions. By testing these reflexes, they can determine if there is any damage or dysfunction in the nervous system.

    • This question is part of the following fields:

      • Neurology
      8.8
      Seconds
  • Question 11 - A 55-year-old man presents with sudden-onset back pain radiating down to his feet....

    Correct

    • A 55-year-old man presents with sudden-onset back pain radiating down to his feet. He reports weakness in his legs and a tingling sensation around his scrotum. He has experienced urinary incontinence a few times today. Upon examination, he displays decreased power, tone, and sensation in both legs and absent ankle reflexes.
      What is the most probable diagnosis?

      Your Answer: Cauda equina syndrome

      Explanation:

      Differential Diagnosis of Back Pain with Neurological Symptoms

      Back pain with neurological symptoms can be a sign of various conditions. Here are some of the differential diagnoses to consider:

      Cauda Equina Syndrome
      This condition occurs when the lumbar and sacral nerve roots are compressed, leading to bilateral sciatica, neurological deficit in the legs, urinary retention or incontinence, faecal incontinence, and saddle paraesthesia. It is an emergency that requires prompt treatment to prevent irreversible damage to the spinal nerves.

      Guillain–Barré Syndrome (GBS)
      GBS is a rare acute polyneuropathy that causes gradually worsening, ascending muscle weakness, usually starting in the legs and potentially affecting respiratory function. It rarely presents with sensory symptoms, making it an unlikely diagnosis for a patient with acute back pain and sciatica.

      Multiple Sclerosis (MS)
      MS is a chronic inflammatory condition of the central nervous system that leads to demyelination. Patients may present with various neurological symptoms, such as visual disturbance, sensory loss, limb weakness, or urinary symptoms. However, sudden onset of back pain is not a typical feature of MS.

      Subacute Combined Degeneration of the Spinal Cord
      This rare condition is caused by untreated vitamin B12 deficiency and presents with gradually developing symptoms, such as unsteadiness, leg weakness, sensory or visual disturbances, and memory problems. However, lower motor-neurone signs in the legs and acute back pain are not typical features of subacute spinal cord degeneration.

      Urinary-Tract Infection (UTI)
      An upper UTI (pyelonephritis) may cause back or loin pain, rigors, vomiting, and urinary symptoms, such as dysuria, increased urinary frequency, or incontinence. However, bilateral sciatica and lower motor-neurone signs are not typical features of a UTI.

    • This question is part of the following fields:

      • Neurology
      18.7
      Seconds
  • Question 12 - A 45-year-old woman with multiple sclerosis comes in for evaluation. She reports experiencing...

    Correct

    • A 45-year-old woman with multiple sclerosis comes in for evaluation. She reports experiencing worsening issues with painful spasms in her leg muscles. What is the initial treatment option that should be considered?

      Your Answer: Baclofen

      Explanation:

      The recommended initial treatments for spasticity in multiple sclerosis are baclofen and gabapentin.

      Multiple sclerosis is a condition that cannot be cured, but its treatment aims to reduce the frequency and duration of relapses. In the case of an acute relapse, high-dose steroids may be administered for five days to shorten its length. However, it is important to note that steroids do not affect the degree of recovery. Disease-modifying drugs are used to reduce the risk of relapse in patients with MS. These drugs are typically indicated for patients with relapsing-remitting disease or secondary progressive disease who have had two relapses in the past two years and are able to walk a certain distance unaided. Natalizumab, ocrelizumab, fingolimod, beta-interferon, and glatiramer acetate are some of the drugs used to reduce the risk of relapse in MS.

      Fatigue is a common problem in MS patients, and amantadine is recommended by NICE after excluding other potential causes such as anaemia, thyroid problems, or depression. Mindfulness training and CBT are other options for managing fatigue. Spasticity is another issue that can be addressed with first-line drugs such as baclofen and gabapentin, as well as physiotherapy. Cannabis and botox are currently being evaluated for their effectiveness in managing spasticity. Bladder dysfunction is also a common problem in MS patients, and anticholinergics may worsen symptoms in some patients. Ultrasound is recommended to assess bladder emptying, and intermittent self-catheterisation may be necessary if there is significant residual volume. Gabapentin is the first-line treatment for oscillopsia, which is a condition where visual fields appear to oscillate.

    • This question is part of the following fields:

      • Neurology
      48.3
      Seconds
  • Question 13 - A 49-year-old male comes to the emergency department complaining of progressive weakness in...

    Correct

    • A 49-year-old male comes to the emergency department complaining of progressive weakness in both legs that started with leg pain a week ago. Upon examination, there is a decrease in patellar reflex bilaterally, and the patient has 3/5 strength throughout the neurological examination in the lower limbs bilaterally, but normal sensation. The patient has no significant medical history and is not taking any regular medications. What is the most probable organism responsible for his symptoms?

      Your Answer: Campylobacter jejuni

      Explanation:

      The patient in this scenario is experiencing leg or back pain before the onset of weakness, which is a common symptom of Guillain-Barre syndrome. The ascending weakness of the legs, along with reduced reflexes and normal sensation, is a typical presentation of this disease.

      Escherichia coli is a frequent cause of traveller’s diarrhoea and gastroenteritis, but it is not associated with Guillain-Barre syndrome.

      Coxsackievirus is the most common cause of viral meningitis in adults, but it is not linked to Guillain-Barre syndrome.

      Herpes simplex virus causes genital and labial sores, but it does not play a role in the development of this disease.

      Understanding Guillain-Barre Syndrome and Miller Fisher Syndrome

      Guillain-Barre syndrome is a condition that affects the peripheral nervous system and is often triggered by an infection, particularly Campylobacter jejuni. The immune-mediated demyelination of the peripheral nervous system occurs due to the cross-reaction of antibodies with gangliosides. Studies have shown a correlation between the clinical features of the syndrome and the presence of anti-ganglioside antibodies, particularly anti-GM1 antibodies, which are present in 25% of patients.

      Miller Fisher syndrome is a variant of Guillain-Barre syndrome that is characterized by ophthalmoplegia, areflexia, and ataxia. Unlike other forms of Guillain-Barre syndrome, Miller Fisher syndrome usually presents as a descending paralysis, with the eye muscles typically affected first. In 90% of cases, anti-GQ1b antibodies are present.

      Understanding the pathogenesis and clinical features of Guillain-Barre syndrome and Miller Fisher syndrome is crucial for accurate diagnosis and effective treatment. Further research is needed to fully understand the mechanisms behind these conditions and to develop more targeted therapies.

    • This question is part of the following fields:

      • Neurology
      227.8
      Seconds
  • Question 14 - A 65-year-old man comes to the General Practitioner with his daughter. She reports...

    Correct

    • A 65-year-old man comes to the General Practitioner with his daughter. She reports that her father’s behavior has changed over the past year. He used to be a very sociable and outgoing man but recently he has become withdrawn and uninterested in his hobbies. He has also become forgetful and has difficulty completing tasks that he used to do easily. The patient tells you that he does not think there is anything wrong with him and he is just getting older.
      Which of the following is the most likely diagnosis?

      Your Answer: Frontotemporal dementia

      Explanation:

      Differentiating Types of Dementia: A Brief Overview

      Dementia is a broad term used to describe a decline in cognitive function that interferes with daily activities. However, there are different types of dementia, each with unique characteristics. Here are some key features to help differentiate between frontotemporal dementia, Alzheimer’s disease, Huntington’s disease, normal-pressure hydrocephalus (NPH), and Parkinson’s disease.

      Frontotemporal Dementia
      This type of dementia is rare and typically affects individuals between the ages of 55 and 65. Early personality and behavior changes are core symptoms, while memory impairment is not typical. Other key features include a gradual progression, decline in social conduct, emotional blunting, and loss of insight.

      Alzheimer’s Disease
      Alzheimer’s disease is the most common form of dementia, affecting individuals over the age of 65. Memory loss is a key early symptom, followed by agitation and obsessive behavior later in the disease course.

      Huntington’s Disease
      Huntington’s disease is a neurodegenerative condition that is often inherited. Symptoms include memory impairment, depression, clumsiness, mood swings, and difficulty concentrating. However, this patient’s symptoms are more consistent with early frontotemporal dementia.

      Normal-Pressure Hydrocephalus (NPH)
      NPH is a reversible cause of dementia characterized by gait abnormality, memory impairment, and incontinence. It may be mistaken for Parkinson’s disease, but symptoms will not improve with levodopa.

      Parkinson’s Disease
      While dementia and hallucinations may develop during the course of Parkinson’s disease, it is primarily a movement disorder characterized by tremors, rigidity, and bradykinesia.

    • This question is part of the following fields:

      • Neurology
      162.4
      Seconds
  • Question 15 - A 75-year-old man presented to the eye clinic with double vision. He has...

    Correct

    • A 75-year-old man presented to the eye clinic with double vision. He has been experiencing this for the past few weeks. During examination, it was observed that he had horizontal diplopia and slight limitation of one of the extraocular muscles in his left eye. The patient has a medical history of hypertension and prostate cancer. Brain imaging revealed a metastatic lesion in the clivus that surrounds the cavernous sinus and carotid artery. Which cranial nerve palsy is responsible for the diplopia in this patient?

      Your Answer: Left sixth cranial nerve (CN6) palsy

      Explanation:

      Understanding the 12 Cranial Nerves and their Functions

      The human body has 12 pairs of cranial nerves that originate from the brainstem and control various functions such as movement, sensation, and reflexes. Each nerve has a specific function and pathway, and damage to any of these nerves can result in various clinical symptoms.

      Some of the important functions of these nerves include smell (olfactory nerve), sight (optic nerve), eye movement (oculomotor, trochlear, and abducens nerves), facial sensation and mastication (trigeminal nerve), facial movement and taste (facial nerve), hearing and balance (vestibulocochlear nerve), taste and swallowing (glossopharyngeal nerve), phonation and innervation of viscera (vagus nerve), head and shoulder movement (accessory nerve), and tongue movement (hypoglossal nerve).

      In addition to their primary functions, some of these nerves also play a role in various reflexes such as the corneal reflex, jaw jerk reflex, gag reflex, carotid sinus reflex, pupillary light reflex, and lacrimation reflex. Understanding the functions and pathways of these cranial nerves is essential for diagnosing and treating various neurological conditions.

    • This question is part of the following fields:

      • Neurology
      42.1
      Seconds
  • Question 16 - A 45-year-old man with hypertension complains of recurring headaches accompanied by sensitivity to...

    Incorrect

    • A 45-year-old man with hypertension complains of recurring headaches accompanied by sensitivity to light, nausea, and occasional vomiting. The headaches usually affect the right side of his head and sometimes cause temporary vision problems. They last up to 10 hours and occur approximately once every 4-6 weeks. The neurological examination and blood pressure are normal.

      What would be the most suitable initial medical treatment for acute attacks? Choose the ONE most appropriate first-line medical treatment from the options provided.

      Your Answer: Sumatriptan

      Correct Answer: Ibuprofen

      Explanation:

      Treatment Options for Migraines: A Comparison of Medications

      Migraines are a recurring type of headache that can last for several hours to a few days. They are often accompanied by symptoms such as sensitivity to light and sound, nausea, and vomiting. There are several medications available for the treatment of migraines, each with its own benefits and drawbacks.

      Ibuprofen is a simple analgesic that is recommended by the National Institute for Health and Care Excellence (NICE) for the treatment of acute migraine attacks. It is safe for patients with ischaemic heart disease, but the daily dose should not exceed 1200 mg.

      Sumatriptan is a serotonin-receptor agonist that causes intracerebral vasoconstriction. It is recommended by NICE for the treatment of acute migraines, but it is contraindicated in patients with a history of ischaemic heart disease.

      Amitriptyline is a tricyclic antidepressant that is used for long-term prophylaxis of migraines. It is recommended by NICE for this use but not for acute treatment.

      Co-codamol, an opiate medication, is not recommended by NICE for the treatment of migraines due to the risk of medication-overuse headache and worsening of nausea and vomiting symptoms.

      Ergotamine tartrate, another medication that was previously used to treat migraines, is now limited in use due to its unpleasant side effects such as nausea and vomiting. NICE advises against its use for the treatment of acute migraines.

      In conclusion, the choice of medication for the treatment of migraines should be based on the patient’s medical history and the severity of their symptoms. Patients should consult with their healthcare provider to determine the best treatment plan for their individual needs.

    • This question is part of the following fields:

      • Neurology
      29.1
      Seconds
  • Question 17 - A 70-year-old female presents with hypothenar eminence wasting and sensory loss in the...

    Correct

    • A 70-year-old female presents with hypothenar eminence wasting and sensory loss in the little finger. What is the probable location of the lesion?

      Your Answer: Ulnar nerve

      Explanation:

      The Ulnar Nerve: Overview, Branches, and Patterns of Damage

      The ulnar nerve is a nerve that arises from the medial cord of the brachial plexus, specifically from the C8 and T1 spinal nerves. It provides motor innervation to several muscles in the hand, including the medial two lumbricals, adductor pollicis, interossei, hypothenar muscles (abductor digiti minimi, flexor digiti minimi), and flexor carpi ulnaris. It also provides sensory innervation to the medial 1 1/2 fingers on both the palmar and dorsal aspects.

      The ulnar nerve travels through the posteromedial aspect of the upper arm before entering the palm of the hand via the Guyon’s canal, which is located superficial to the flexor retinaculum and lateral to the pisiform bone. The nerve has several branches, including the muscular branch, palmar cutaneous branch, dorsal cutaneous branch, superficial branch, and deep branch. These branches supply various muscles and skin areas in the hand.

      Damage to the ulnar nerve can occur at the wrist or elbow. When damaged at the wrist, it can result in a claw hand deformity, which involves hyperextension of the metacarpophalangeal joints and flexion at the distal and proximal interphalangeal joints of the 4th and 5th digits. There may also be wasting and paralysis of intrinsic hand muscles (except lateral two lumbricals) and hypothenar muscles, as well as sensory loss to the medial 1 1/2 fingers. When damaged at the elbow, the same symptoms may occur, but with the addition of radial deviation of the wrist. It is important to note that in distal lesions, the clawing may be more severe, which is known as the ulnar paradox.

    • This question is part of the following fields:

      • Neurology
      18.7
      Seconds
  • Question 18 - A 68-year-old woman complains of experiencing multiple instances of sharp, shooting 'electric shock'...

    Correct

    • A 68-year-old woman complains of experiencing multiple instances of sharp, shooting 'electric shock' like pain on the right side of her face over the last 8 months. These episodes usually occur while she is brushing her hair. What is the recommended treatment for this likely diagnosis?

      Your Answer: Carbamazepine

      Explanation:

      Typical symptoms of trigeminal neuralgia are present in this woman. The initial treatment recommended for this condition is carbamazepine, which should be initiated at a dosage of 100 mg twice daily and gradually increased until pain relief is achieved.

      Understanding Trigeminal Neuralgia

      Trigeminal neuralgia is a type of pain syndrome that is characterized by severe pain on one side of the face. While most cases are idiopathic, some may be caused by compression of the trigeminal roots due to tumors or vascular problems. According to the International Headache Society, trigeminal neuralgia is defined as a disorder that causes brief electric shock-like pains that are limited to one or more divisions of the trigeminal nerve. The pain is often triggered by light touch, such as washing, shaving, or brushing teeth, and can occur spontaneously. Certain areas of the face, such as the nasolabial fold or chin, may be more susceptible to pain. The pain may also remit for varying periods.

      Red flag symptoms and signs that suggest a serious underlying cause include sensory changes, ear problems, a history of skin or oral lesions that could spread perineurally, pain only in the ophthalmic division of the trigeminal nerve, optic neuritis, a family history of multiple sclerosis, and onset before the age of 40.

      The first-line treatment for trigeminal neuralgia is carbamazepine. If there is a failure to respond to treatment or atypical features are present, such as onset before the age of 50, referral to neurology is recommended. Understanding the symptoms and management of trigeminal neuralgia is important for proper diagnosis and treatment.

    • This question is part of the following fields:

      • Neurology
      23.2
      Seconds
  • Question 19 - A 35-year-old man visits his family doctor complaining of recurrent episodes of severe...

    Correct

    • A 35-year-old man visits his family doctor complaining of recurrent episodes of severe facial pain that have been occurring for the past 6 months. He reports experiencing sharp shooting pains in his right cheek and teeth, which worsen during the cold winter months and when he brushes his teeth. Despite visiting the dentist multiple times, no abnormality has been found. His neurological and ENT examination is normal.
      What is the most suitable primary care treatment for this condition?

      Your Answer: Carbamazepine

      Explanation:

      Comparing Medications for Trigeminal Neuralgia Treatment

      Trigeminal neuralgia is a condition characterized by severe facial pain that occurs in one or more branches of the trigeminal nerve. To treat this condition, anticonvulsant medications are often prescribed. Here, we compare five commonly used medications for trigeminal neuralgia treatment.

      Carbamazepine is the recommended first-line treatment for trigeminal neuralgia by the National Institute for Health and Care Excellence (NICE). Topiramate is not typically used for trigeminal neuralgia, as it is primarily indicated for migraine prophylaxis. Amitriptyline is recommended for neuropathic pain, but not specifically for trigeminal neuralgia. Duloxetine is also indicated for neuropathic pain, but not for trigeminal neuralgia. Gabapentin is recommended for neuropathic pain, but not for trigeminal neuralgia, as carbamazepine is the preferred first-line treatment for this condition.

      In summary, carbamazepine is the recommended first-line treatment for trigeminal neuralgia, while the other medications mentioned may be more appropriate for other conditions.

    • This question is part of the following fields:

      • Neurology
      40.6
      Seconds
  • Question 20 - A 30-year-old male presents with a bilateral high-stepping gait. He is typically healthy,...

    Correct

    • A 30-year-old male presents with a bilateral high-stepping gait. He is typically healthy, works as a personal trainer, and enjoys rock climbing in his free time. During the examination, there is bilateral weakness of dorsiflexion (3/5) and slightly decreased sensation over the dorsal aspect of his feet. The compression of which nerve do you suspect is responsible for his symptoms, possibly caused by his high rock climbing boots?

      Your Answer: Common fibular nerve

      Explanation:

      Damage to the common peroneal nerve can result in weakened dorsiflexion and eversion of the foot. The nerve runs laterally through the popliteal fossa and over the neck of the fibula before entering the medial compartment of the leg. This area is susceptible to compression or injury, leading to sensory and motor impairments. In this case, the individual’s tight abseiling boots have been compressing their common peroneal nerve.

      Understanding Common Peroneal Nerve Lesion

      A common peroneal nerve lesion is a type of nerve injury that often occurs at the neck of the fibula. This nerve is a branch of the sciatic nerve, which divides into the tibial and common peroneal nerves. The most notable symptom of this type of nerve damage is foot drop, which is characterized by weakness or paralysis of the muscles that lift the foot.

      In addition to foot drop, other symptoms of a common peroneal nerve lesion may include weakness in foot dorsiflexion and eversion, as well as the extensor hallucis longus muscle. Sensory loss may also occur over the dorsum of the foot and the lower lateral part of the leg, and there may be wasting of the anterior tibial and peroneal muscles.

      Overall, understanding the symptoms of a common peroneal nerve lesion can help individuals recognize and seek treatment for this type of nerve injury. With proper care and management, it may be possible to improve symptoms and prevent further damage to the affected nerve.

    • This question is part of the following fields:

      • Neurology
      23
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (18/20) 90%
Passmed