MRCP Part 2 Category: Neurology

MRCP2-3356

A 58-year-old woman presents to the acute medical unit with a frontal headache that has been worsening, along with nausea and pins and needles in her distal right upper limb. She was born in India and moved to the United Kingdom three years ago. Her medical history includes tuberculosis that was treated 10 years ago and rheumatoid arthritis, for which she has recently started taking methotrexate, sulfasalazine, and a short course of oral prednisolone. Her chest X-ray was normal, and the quantiFERON test was negative when she entered the UK.

Upon examination, the patient appears well and is alert and oriented. Her vital signs are within normal limits, and there is symmetrical swelling in the small joints of both hands. Neurological examination reveals 4/5 MRC grade of power in the distal right upper limb. Examination of the cardiovascular, respiratory, and abdominal systems reveals no additional abnormalities.

The patient’s investigation results are as follows:

– Hb 124 g/L
– Platelets 398* 109/L (150 – 400)
– WBC 12 * 109/L (4.0 – 11.0)
– Na 135 mmol/L (135 – 145)
– K 3.6 mmol/L (3.5 – 5.0)
– Urea 5 mmol/L (2.0 – 7.0)
– Creatinine 63 µmol/L (55 – 120)
– CRP 24 (< 5) A contrast CT head is arranged, which shows a 3-4 cm diameter homogeneous contrast-enhancing round lesion adjacent to the meningeal membrane situated in the left frontal lobe with evidence of surrounding edema and mass effect. No additional lesions are noted, and there is no evidence of acute ischemia, hemorrhage, or collection. What is the most likely diagnosis?

MRCP2-3357

A 24-year-old man is brought to the ITU after being medically transferred from India. He had been travelling in India for approximately four weeks before experiencing symptoms of illness. According to his girlfriend, he was behaving unusually and had several seizures before being admitted to a hospital in Patna, eastern India. The patient underwent a scan and a surgical procedure in India, which was ultimately abandoned.

A CT scan of the head with contrast is conducted:

What is the probable diagnosis?

MRCP2-3358

A 50-year-old woman comes to the Emergency Department complaining of a headache that has been progressively worsening for the past 3 months. Despite trying various treatments such as a triptan, amitriptyline, and standard pain relief, prescribed by her GP, she has not experienced much relief. She is a non-smoker and consumes approximately 30 units of alcohol per week.

Upon conducting a neurological examination, no abnormalities are detected. A CT scan is ordered:

What is the most probable diagnosis?

MRCP2-3359

A 35-year-old woman arrives at the Emergency Department complaining of a severe headache. She reports collapsing while on her way to work and has been experiencing a severe occipital headache since then. Her vital signs are stable, except for a low-grade fever of 37.5ºC, and her GCS is 15/15. Despite taking analgesics, her headache does not improve, and a CT head with contrast is ordered:

What is the result of the scan?

MRCP2-3360

A 6-year-old girl falls from the top of a swing and is taken to the Emergency Department. She is crying, complaining of a severe headache and regularly vomiting. A CT head is performed:

What does the scan show?

MRCP2-3361

A 78-year-old man is brought to the Emergency Department by ambulance after being discovered in an unresponsive, drowsy state. His son had called earlier in the day and was told that his father had a headache. Upon arriving at his father’s home, he found him confused and lying on the floor.

During examination, the patient’s GCS is 9/15 (M4V3E2), pulse is 96/min, and blood pressure is 140/78 mmHg. A CT head scan is ordered:

What is the most probable diagnosis?

MRCP2-3346

A 72-year-old man comes in with left sided claw hand, right sided foot drop, right sided abducens palsy, and a loss of sensation over the back of the right forearm. His ESR is 70 mm per hour (0-20) and he has neutrophilic leukocytosis. Primary axonopathy is revealed in nerve conduction studies. What is the most probable diagnosis?

MRCP2-3362

A 68-year-old male is brought to the emergency department by ambulance after experiencing his third episode of limb jerking in 72 hours witnessed by his wife. Upon arrival, the patient becomes increasingly unresponsive and exhibits small amplitude jerking in all four limbs. While the resus nurse obtains midazolam two minutes into his seizure, it is noted that his eyes are tightly closed and cannot be forcefully opened to check pupillary reflexes. The amplitude of his limb jerking also increases. Blood is observed on his tongue and he experiences urinary incontinence, but there is no evidence of head or limb injury. The seizure spontaneously terminates before any medication is administered, approximately 6 minutes after onset. The patient becomes increasingly responsive about 2 minutes after the end of limb jerking and appears tearful, expressing apologies for the inconvenience caused. What is the most likely diagnosis?

MRCP2-3347

A 45-year-old woman presents with a sudden and severe headache at the back of her head, accompanied by nausea and vomiting. Upon examination, it is discovered that she has an intracranial hemorrhage caused by a bleed from a posterior communicating artery aneurysm. The patient undergoes surgical clipping of the aneurysm and initially appears to be recovering well. However, on the third day after the operation, she becomes increasingly drowsy and confused. Despite instituting a fluid restriction, her condition fails to improve. Further tests reveal abnormal levels of plasma sodium and potassium. What is the most likely cause of the patient’s confusion?

MRCP2-3363

A 56 year old man experiences a gradual onset of hand clumsiness, difficulty walking, and trouble swallowing over the course of several months. His voice has also become high-pitched and nasal. Despite these symptoms, his sensory examination has remained normal. He has up-going plantars, absent ankle reflexes on both sides, and muscle wasting in his lower legs. What treatment has been proven to extend the lifespan of the underlying condition?