Archives: MRCP Part 2

MRCP2-3154

A 25-year-old woman presents to a general neurology clinic with complaints of increasing clumsiness with heavy objects over the past year. She reports difficulty washing her hair and completing household chores such as hanging up laundry. On neurological examination, her upper limb power is graded using the MRC system. Her left arm has 3/5 power for shoulder abduction and 4/5 power for shoulder adduction, while her right arm has 3/5 power for shoulder abduction and 4/5 power for shoulder adduction. Reflexes are normal except for an inability to elicit the supinator reflex on the right side. Sensation is intact. Cranial nerve examination reveals drooping of the eyelids and decreased facial expression. Fatigability tests are unremarkable. What is the most likely diagnosis?

MRCP2-3155

A 25-year-old man attends the Epilepsy Clinic. He has suffered tonic-clonic seizures for 7 years. After initial poor response, his epilepsy is now well-controlled on sodium valproate 1.5 g daily. He has been seizure-free for 3 years. His compliance with therapy is good.

From review of his case sheet, you note a family history of cerebrovascular disease with both grandparents suffering stroke.

At time of diagnosis, magnetic resonance imaging (MRI) brain showed no structural abnormality and interictal electroencephalogram (EEG) was unremarkable.

He is concerned over weight gain and hair loss that he attributes to his anticonvulsant therapy. He is considering stopping his sodium valproate.

What feature in his history predicts seizure recurrence upon discontinuation of therapy?

MRCP2-3156

A 40-year-old man presents to the Emergency department after being assaulted in the city centre. He sustained multiple knife wounds, including two in the left groin. On examination, there is reduced power of hip flexion and knee extension on the left, along with reduced sensation over the medial aspect of the left thigh. What is the probable cause of his symptoms?

Investigations revealed normal full blood count and biochemistry, with a glucose level of 5.6 mmol/L (3.0-6.0) and a prothrombin time of 11.5 s (11.5-15.5). A plain x-ray of the pelvis showed no evidence of fracture. The patient is a previously fit individual who smokes 10 cigarettes per day and drinks approximately 20 units of alcohol per week.

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?

MRCP2-3159

A 35-year-old woman presents to the neurology clinic with a history of intermittent headaches for the past 6 months. The headaches predominantly affect the left side of her head and are accompanied by paraesthesia in her left hand, as well as occasional nausea and vomiting. The patient reports that her symptoms usually resolve after 4-6 hours. She has no significant medical history and is not taking any regular medications or has any allergies.

Upon examination, the patient’s vital signs are within normal limits. There is no sensory or coordination disturbance, and all four limbs have equal power. The cranial nerve examination is unremarkable.

What would be the most appropriate course of action for the long-term management of this patient?

MRCP2-3140

An 88-year-old lady with a history of Parkinson’s disease and repeated admissions for aspiration pneumonias is admitted to the hospital with symptoms of diarrhoea, vomiting, malaise, stiffness, tremor, fever, and hallucinations. Her current medications include co-beneldopa, warfarin, amlodipine, amitriptyline, metformin, and lactulose. On examination, she is agitated, and a chest x-ray and abdominal examination are unremarkable. Blood tests reveal elevated creatinine, INR, and CRP levels, as well as positive ketones and trace blood in her urine. What would be the most appropriate next step in managing this patient’s condition?

MRCP2-3141

A 35-year-old woman is brought to the Intensive Care Unit after a serious head injury. She meets the requirements for brainstem death and has a registered organ donor card. However, her family is opposed to organ donation.

What is the best course of action in this situation?

MRCP2-3142

A 55-year-old construction worker presents to the hospital after collapsing on the job. He is a smoker of 15 cigarettes per day but has no other medical history. Upon awakening at the construction site, he experienced slurred speech, dizziness, and temporary symptoms on the left side of his body. These symptoms had resolved by the time he arrived at the Emergency Department. Imaging revealed a proximal stenosis of the right subclavian and carotid arteries. EEG results were negative for spike activity. What is the most likely diagnosis based on this clinical presentation?

MRCP2-3143

A 25-year-old woman was brought to the Emergency Room by her sister as she had been exhibiting aggressive behavior and was difficult to handle, both at work and home, for the past few months. She had a habit of touching other people and would occasionally make strange noises and shout obscenities without any reason.
During the examination, she repeatedly blinked her eyes and had involuntary twitches. Other than that, the neurological examination was normal. There were no significant findings on the general physical examination, with a regular pulse of 80 bpm and blood pressure of 120/80 mmHg.
What is the most probable diagnosis?