MRCP Part 2 Category: Neurology

MRCP2-3297

An 80-year-old woman visits her GP with patchy dysesthesia affecting her feet bilaterally. She denies any back pain and reports no recent changes in her bowel habits. She experiences stress incontinence, but her urinary symptoms have not changed recently. Upon examination, there is no weakness, and reflexes are intact. Her medical history includes hypertensive nephropathy and diet-controlled type 2 diabetes. She takes amlodipine 10mg, ramipril 5mg, and bendroflumethazide 2.5mg for her hypertension, and for the past year, nitrofurantoin 100 mg as prophylaxis for urinary tract infections.

Na+ 135 mmol/l
K+ 4.2 mmol/l
Urea 10.8 mmol/l
Creatinine 186 µmol/l
Glucose 8.3 mmol/l

What is the most probable cause of her symptoms?

MRCP2-3282

A 65-year-old female is admitted to the acute medical unit after experiencing a prolonged tonic-clonic seizure. She has been diagnosed with status epilepticus and treated with lorazepam and a phenytoin infusion. Two days later, you are consulted to assess her ongoing confusion. The patient has a history of depression and is currently taking fluoxetine.

Upon examination, her cardiorespiratory system appears normal, and her abdomen is soft and non-tender. However, you notice rapid blinking, which the nursing staff confirms has been ongoing for the past 24 hours.

The following are the results of her investigations:

– Hb 135 g/l
– Na+ 137 mmol/l
– Bilirubin 14 µmol/l
– CRP <4 mg/l
– Lactate 1.2 mmol/l
– Albumin 32 g/l
– Platelets 385 * 109/l
– K+ 4.2 mmol/l
– ALP 88 u/l
– WBC 6.6 * 109/l
– Urea 4.4 mmol/l
– ALT 44 u/l
– Neuts 4.2 * 109/l
– Creatinine 75 µmol/l
– γGT 68 u/l
– Lymphs 2.2 * 109/l
– Eosin 0.2 * 109/l

What is the most likely diagnosis?

MRCP2-3298

A 60-year-old man presents to you after being diagnosed with Parkinson’s disease by a specialist in secondary care. His condition has worsened over the past year and a half, leading to significant functional disability. He has been advised by his Parkinson’s disease specialist nurse to consider drug treatment and has an upcoming appointment with his consultant to discuss this. However, he is confused about the different types of drugs available and wants to know the likely options. What class of drug would be appropriate for initial pharmacotherapy in this patient?

MRCP2-3283

A 56-year-old woman presents to the neurology clinic with paraesthesia and a burning sensation down her right side. She had a similar episode two years ago, which resolved on its own. MRI brain and spinal cord revealed multiple sclerosis with areas of T1 weighted hypointensities and T2 weighted hyperintensities. What factor in this case indicates a poor prognosis?

MRCP2-3299

A 25-year-old man is brought to the Emergency Department by his friends as they have noticed him acting strangely over the last 6 months. His friends are particularly concerned about his excessive drinking and going out without informing them. They have also noticed his walking has become progressively more unsteady and he often slurs his speech. His mother has a history of depression and his father has a history of seizures.

On examination, he has coarse nystagmus to lateral gaze bilaterally, slurred speech, and an ataxic gait. The rest of his neurological examination is normal.

What is the most likely diagnosis?

MRCP2-3284

A 16-year-old female presents with a gradual loss of vision over the past year, but denies any headaches. She has no history of medication use or illicit substance abuse, and her medical and family history are unremarkable. She does not smoke or drink alcohol. On examination, she has a BMI of 32.3 kg/m2 and a blood pressure of 120/68 mmHg. Neurological examination is normal, but fundoscopy reveals bilateral blurred and heaped up optic discs that are noticeably pale. A CT head scan was normal. What is the appropriate investigation for this patient?

MRCP2-3269

A 45-year-old woman with a history of schizophrenia and multiple hospitalisations presents in a psychiatry ward with a few weeks of feeling unwell and stiffness in her jaws and arms. She has been on haloperidol for symptom control. Her temperature is 38.5°C and BP is 175/85 mmHg. What is the most crucial investigation to conduct?

MRCP2-3270

A 63-year-old woman presents with difficulty lifting her right arm after undergoing a laparoscopic cholecystectomy three weeks ago. She had severe pain in her right shoulder that slowly improved, but now has weakness in shoulder abduction, scapular winging, and sensory loss over the outer aspect of the upper arm on the right. What is the probable diagnosis?

MRCP2-3271

A 56-year-old man presents to the Neurology Department with persistent headaches and nausea, along with recent memory problems. His family is concerned about his forgetfulness. The patient has a history of mild hypertension controlled by diet and worked at a petrochemical plant for 24 years. Routine lab tests were normal, but imaging revealed a hypodense mass with cerebral edema in the left temporal lobe. What clinical signs would have most accurately localized this lesion to the temporal lobe?

MRCP2-3272

A 75-year-old man presents to the Falls Clinic after his third visit to the Emergency Department in the past six months for syncope. His wife is worried because he has been increasingly confused and has had episodes of urinary incontinence. He has a history of hypertension and usually takes indapamide, but stopped on the advice of his General Practitioner. On examination, he has an ataxic gait and evidence of cerebellar dysfunction. He also has a parkinsonian facial appearance with minor tremors on the left side. His blood pressure drops significantly upon standing. There are no murmurs, chest is clear, and there is no ankle swelling. His BMI is 22 kg/m2 and routine bloods are normal. What is the most likely diagnosis?