An 82-year-old man comes to the hospital complaining of increasing confusion, urinary incontinence, and falls over the past three months. A confusion screen is conducted, and blood tests reveal low B12 levels, but are otherwise normal. CT brain scan shows enlarged ventricles, and a lumbar puncture is performed, revealing normal CSF with an opening pressure of 15 cmH2O. The patient’s symptoms improve slightly after 30 mls of CSF are removed. What is the most definitive course of action for treating this patient?
MRCP2-3235
A 25-year-old man with a history of epilepsy presents to the Emergency department after experiencing a series of tonic-clonic convulsions at home. He is currently taking sodium valproate as his only prescribed medication. Upon examination, he is found to be unconscious and having continuous seizures. To maintain his airway, he is placed into a lateral position and given 10 L/min of oxygen via a high-flow mask. Intravenous access is established and he is given intravenous lorazepam, but continues to have seizures. Two more boluses of lorazepam are given at five-minute intervals, but he experiences another generalised convulsion 30 minutes later. What should be the next course of action?
MRCP2-3236
A 30-year-old female presents to the Emergency Department with progressive weakness in her lower limbs over the past three days. She is now unable to walk and has noticed clumsiness in her fingers. Upon examination, her heart rate is regular at 65 beats per minute, blood pressure is 125/70 mmHg, and respiratory rate is 20 breaths per minute. Ankle and knee jerks are absent, and upper limb reflexes are reduced.
Based on her likely diagnosis, what is the most important parameter to monitor throughout her hospitalization?
MRCP2-3237
A 65-year-old retired accountant was referred to the neurology clinic by his GP due to a three-month history of malaise and weakness. Initially, he experienced weakness in his legs, but over the last month, he also noticed weakness in his hands, especially his left hand. His speech had also changed in tone. He had a medical history of hypertension, hypercholesterolaemia, depression, and hypothyroidism. On examination, he appeared cachectic with obvious dysarthria. Investigations conducted by the GP prior to referral showed anemia, thrombocytopenia, leukocytosis, and positive ANA. Which intervention is most likely to be beneficial for this patient?
MRCP2-3238
A 70-year-old male visits the Parkinson’s clinic with his spouse, complaining of more frequent and longer ‘off’ periods. The couple finds these episodes highly debilitating and occur up to 10 times a day. The patient was diagnosed with Parkinson’s disease 10 years ago. As a relatively young patient on diagnosis, he was started on ropinirole, which he continued for 4 years, before being prescribed Sinemet 5 times a day and entacapone for the following 6 years. Over the last 2 years, the ‘off’ episodes have gradually increased in frequency, along with the development of very mild involuntary jaw movements. He is feeling very low and has been to the emergency department twice with attempted paracetamol overdoses. He would like a more effective treatment. What treatment plan would you suggest?
MRCP2-3239
A 30-year-old woman who is 34 weeks pregnant and has a history of pregnancy induced hypertension presents to the Emergency Department after experiencing headaches and a seizure at home. Upon arrival, she has neurological symptoms indicative of an intracerebral bleed and a blood pressure reading of 195/85 mmHg.
What is the best immediate action to take in this situation?
MRCP2-3240
You encounter a 45 year-old man who has been referred to the neurology clinic by his GP.
He reports experiencing facial pain for the past year. The pain is particularly severe when he is shaving or brushing his teeth, and he describes it as a ‘stabbing’ sensation that goes through the teeth of his upper jaw and over the right side of his face. Despite seeing multiple dentists and having several teeth removed, he has not found any relief. The pain has been progressively worsening, and whereas before it occurred in distinct episodes, it now occurs almost constantly. He has read various online sources and has become convinced that he has a brain tumor, which has caused him to become depressed and withdrawn.
His medical history includes essential hypertension, for which he takes perindopril. He also has a history of sinusitis and has undergone sinus washouts on multiple occasions. Two years ago, while on a business trip abroad, he experienced vision problems in his left eye that resolved spontaneously over a few weeks, and for which he did not seek medical attention.
Upon examination, there are no notable findings. Cranial nerve examination is mostly normal, but you observe a patch of numbness on the right cheek. Muscle strength is 5/5 in all limb groups, reflexes are normal, and plantar responses are downward. Sensation in the limbs is normal.
What is the most appropriate course of action?
MRCP2-3241
A 35-year-old woman presented to the Outpatient Clinic with a history of recurrent headaches for the last 6 months. These occur up to four times per day and last 20–40 min each time. She described two periods during these 6 months, one lasting 3 weeks and the other lasting 5 weeks, when the headaches occurred and that she had been headache free in between these times. She described experiencing severe left-sided pain behind the eye and she often noticed that the left eye became red and teary.
On examination, her BP is 118/70 mmHg, pulse is 72 bpm and regular and her BMI is 23. Physical examination, including full neurological exam, is entirely normal.
Which one of the following medications is most likely to be effective in preventing future headaches?
MRCP2-3242
What is the probable diagnosis for a 29-year-old man who had a right-sided middle cerebral artery territory infarct and has a history of focal impaired awareness seizures, difficult-to-treat migraines, recurrent vomiting, tremors, and muscle weakness with atrophy?
MRCP2-3243
A 59-year-old male presents with his fourth episode of binocular visual phenomenon over the past 10 months. He describes these episodes as ‘lights’ and ‘white dots’ in his field of vision. He denies any limb or facial weakness or sensory loss. He denies having a headache. He is an active smoker, with a 50 pack year smoking history and has known hypertension on ramipril 5mg OD. Your neurological exam is unremarkable; CT head demonstrates no acute infarct or haemorrhage. MRI head is unremarkable.