MRCP Part 2 Category: Neurology

MRCP2-3529

A 82-year-old woman presents with poor mobility and lethargy. Her husband called for an ambulance when he had difficulty waking her up in the morning. She would briefly open her eyes in response to his voice before falling back asleep. She typically uses a Zimmer frame to walk and had fallen the week before being admitted. Her medical history includes hypertension and diabetes.

During examination, her Glasgow coma scale was reduced to 13/15 and both planters were upgoing. An urgent CT head scan was ordered, revealing evidence of bilateral subdural hematomas.

Which vessel is affected in this case?

MRCP2-3530

A 35-year-old male patient arrives at the Emergency department with a medical history of epilepsy. He reports experiencing jerking movements starting from the left corner of his mouth, which then spread to his left thumb and index finger. Eventually, his entire left side began to jerk, but the movements subsided after ten minutes. Following the episode, he experienced weakness on his left side for several hours. Despite this, he maintained full consciousness throughout the event. What is the probable diagnosis?

MRCP2-3531

A house officer is asked to review a patient on her ward as the nurses are concerned about the patient’s speech. The house officer reports that the patient has unilateral weakness of her right face, arm and leg, dysphasia and a visual field defect. She reports that reflexes are brisk on the right and that the tone of the limbs is increased. There is no dysdiadochokinesia on the left, but she is unable to assess on the right arm. The patient’s heart rate is 65, blood pressure 198/100 mmHg and respiratory rate 14. Jugular venous pressure is 2 cm above the sternal notch. Pupils react to light and are consensual. The patient’s family is present who report that the symptoms were sudden in onset. The family is unsure about past medical history, but a list of medications includes warfarin, bendroflumethiazide, ramipril, atorvastatin and allopurinol. A CT head reveals a cerebral infarct.

How would this stroke be classified?

MRCP2-3532

A 27-year-old female from the travelling community presents to A&E after experiencing a seizure. According to her family, she had been suffering from headaches for the past 24 hours and had been feverish and vomiting this morning. Her partner reports that she was unwell with a fever and whole body rash that resolved on its own about a month ago. She has no significant medical history.

During the examination, she appears drowsy and has a left-sided hemiparesis with bilateral nystagmus. Papiloedema is observed during fundoscopy, but there are no skin rashes.

What is the most likely underlying diagnosis?

MRCP2-3533

An 82-year-old man presents to the Emergency Department after experiencing slurred speech and facial drooping for an hour. He has a medical history of type II diabetes, hypertension, and hypercholesterolemia. CT scan shows ischaemia in the right middle cerebral artery (MCA) territory, and his NIHSS score is 14. He receives alteplase therapy and undergoes endovascular thrombectomy in the Interventional Radiology Suite. However, 12 hours later, the nurse observes a decrease in his GCS score, and a repeat CT scan reveals haemorrhagic transformation (HT) in the MCA territory. What is the most significant risk factor for HT in ischaemic stroke?

MRCP2-3534

A 35-year-old woman has just received a diagnosis of Becker’s muscular dystrophy (BMD). As her healthcare provider, what clinical advice would you give her about her condition?

MRCP2-3535

A 35-year-old amateur runner presents to the Neurology Clinic for evaluation. She reports experiencing involuntary muscle twitching, mainly in her arms and legs, for the past few months. This is particularly noticeable after a long run. On examination, she appears healthy, and her BMI is 23. She has well-defined limb muscles. Neurological examination is unremarkable. The following investigations were performed:

Haemoglobin (Hb) 142 g/l 135–175 g/l
White cell count (WCC) 5.8 × 109/l 4.0–11.0 × 109/l
Platelets (PLT) 210 × 109/l 150–400 × 109/l
Sodium (Na+) 138 mmol/l 135–145 mmol/l
Potassium (K+) 4.2 mmol/l 3.5–5.0 mmol/l
Creatinine (Cr) 75 μmol/l 50–120 µmol/l
Erythrocyte sedimentation rate (ESR) 7 mm/hour < 10mm/hour
Electromyography (EMG) Normal conduction velocity

What is the most probable diagnosis?

MRCP2-3536

You assess a 30-year-old motorcyclist who was in a motor vehicle accident and presents with weakness in the left leg. The admitting registrar suspects Brown-Séquard syndrome. During your examination, which of the following clinical signs on the right lower limb would you expect to observe?

MRCP2-3537

You review a 42-year-old man who plays Sunday league rugby for his local club. He reports experiencing numbness in his left middle and index fingers. Upon examination, you note weakness of finger extensors and an absent triceps reflex. What is the most likely location of the lesion?

MRCP2-3538

A 40 year-old man presents with an acute onset of weakness in the left face, arm, and leg, which has not resolved. On examination, there is upper motor neuron facial weakness on the left, with dense weakness of the left arm and leg. There is no evidence of sensory neglect, hemianopia, or dysphasia.

His past medical history includes migraine with visual aura, for which he takes propranolol and sumatriptan. His last migraine attack was a month ago. He has suffered two transient ischaemic attacks in the last year, and now also takes clopidogrel. His father also suffered from migraine with aura and died in his 50s after suffering a series of strokes.

Plain computed tomography shows multiple round lesions in the white matter, which appear the same density as cerebrospinal fluid. Magnetic resonance imaging shows scattered well-circumscribed lesions in the subcortical white matter which appear hypointense on T1 and hyperintense on T2-weighted sequences. On DWI (diffusion-weighted imaging) there is a hyperintense lesion in the right internal capsule, with a corresponding hypointense area on the ADC (apparent diffusion coefficient) map.

What is the most likely underlying diagnosis?