MRCP Part 2 Category: Neurology

MRCP2-3165

You are requested to assess a 20-year-old female who has been admitted after experiencing multiple seizures. The patient has had several seizures on the ward that have either stopped spontaneously after a few minutes or after receiving intravenous lorazepam. The nursing staff suspects that the seizures are not epileptic in origin and asks you to evaluate the patient during her next seizure. During examination, her blood pressure is 135/72 mmHg, her pulse is regular at 80/min, and her BMI is 29. There are self-inflicted scars on both of her forearms. The neurological examination appears normal, and she is not disoriented after the seizure.
Which of the following characteristics is the most indicative that this is a non-epileptic seizure?

MRCP2-3166

A 28-year-old man is anxious about his family history of early onset Alzheimer’s disease. His father, who is 55 years old, was recently diagnosed with the condition, and his 35-year-old brother is experiencing mild cognitive impairment. The patient visits the genetics clinic for evaluation, and his physical examination and mini-mental state examination are unremarkable. Which gene mutation is most likely responsible for his father’s Alzheimer’s disease?

MRCP2-3167

A 32-year-old man presents to the Genetics Clinic for evaluation. He experiences muscle weakness, bilateral ptosis, and cataracts. His first child was born with a bluish tint and needed help breathing in the first few minutes after birth. The father of the child has a history of cataracts but is in good health otherwise. What is the condition affecting the father?

MRCP2-3168

A 50-year-old woman arrived at the emergency department with persistent fever and fatigue. Upon examination, she displayed signs of subacute bacterial endocarditis and a new heart murmur. An ECHO revealed vegetations on her aortic valve, but her blood culture results are still pending. The patient has a history of myasthenia gravis and has been advised to avoid certain types of antibiotics.

Which antibiotics should be avoided in this patient to prevent exacerbation of her myasthenia gravis symptoms?

MRCP2-3169

A 50-year-old male patient is diagnosed with an aggressive glioma after presenting with an inaugural seizure. What is the next step in the standard of care for this tumour, given its aggressive nature?

MRCP2-3170

A 42-year-old male patient complains of weakness that began in his feet and hands and has now spread to his limbs, making it difficult for him to swallow. He recently had food poisoning, which has since resolved.

Which of the following test results is the best predictor of the need for invasive ventilation in the near future?

MRCP2-3171

A 16-year-old girl has been experiencing severe back pain for the past two days. Despite undergoing a plain x-ray film of her spine, the results came back normal. However, two days later, she began to feel tingling sensations in her fingers and toes. The following day, she felt generally weak and decided to seek medical attention at the emergency department.

Upon examination, the girl displayed bilateral lower motor neurone facial weakness, tetraparesis with weakness in all limbs (4/5), areflexia, flexor plantars, and normal sensation. A lumbar puncture was performed, and the CSF analysis showed protein levels of 1.4 g/L (<0.4), normal glucose levels, and 0 cells (<5 ml−1). What is the most likely diagnosis?

MRCP2-3172

You are requested to assess a 25-year-old male patient who has been admitted to the hospital with an ascending muscle weakness that started in his toes but has now spread to all his limbs. He is experiencing shallow breathing and has no reflexes, although he has preserved sensation. At present, his cranial nerve examination is normal, and he is fully oriented. He has no medical history except for a bout of diarrhea three weeks ago, and he is not taking any medications. What is the probable diagnosis?

MRCP2-3157

A 44-year-old woman presents to the emergency department with symptoms of dysphasia, visual disturbance, and weakness that have been ongoing for two hours. Upon examination, she is found to have left homonymous hemianopia, left-sided hemiparesis with sensory loss, and dysphasia. Her vital signs are stable, with a heart rate of 102/min and blood pressure of 145/82 mmHg.

An urgent CT head and angiography are scheduled, which reveal a large infarct in the territory of the middle cerebral artery in the right cerebrum, with proximal occlusion seen on the CT angiography.

The patient has no significant medical history, and her blood work is normal. Her modified Rankin score is 1, and her national institutes of health stroke scale (NIHSS) is 12.

Given that four hours have passed since presentation, what is the next most appropriate course of action in her management?

MRCP2-3158

A 25-year-old man visits the neurology clinic after experiencing his second seizure. According to his partner, the patient becomes unresponsive and appears to be ‘staring into space’ during these episodes. The patient has no memory of these events but does recall feeling nauseous and disorientated for several hours afterward.

All blood tests to identify electrolyte abnormalities come back normal, and an MRI of the head shows no abnormalities. However, an EEG reveals interictal epileptiform discharges.

What would be the most appropriate first-line drug therapy for this likely diagnosis?