Archives: Medical Student Finals

MSFinals-3200

A 68-year-old man came to the Emergency Department following a seizure at home, which he had never experienced before. He experienced moderate weakness on his left side during the initial postictal period, which quickly subsided. He is disoriented, and his wife reports that he has been experiencing dull, throbbing headaches that he can feel throughout his head. He has a medical history of hypertension and type II diabetes, which he manages with an ACE inhibitor and metformin. Upon neurological examination, the patient exhibits reduced strength in his right upper limb.

What is the definitive diagnostic test for this patient?

MSFinals-3163

A 42-year-old teacher comes to the general practitioner (GP) worried about her risk of developing Alzheimer’s disease. Her father has been diagnosed with an advanced form of the condition, and although she has no symptoms, the patient is anxious, as she has heard recently that the condition can be inherited.
Which one of the following statements regarding Alzheimer’s disease is true?

MSFinals-3164

A middle-aged homeless alcoholic who frequently attends the Emergency Department is brought by ambulance, having been found unconscious on the street. He had been examined the previous day with head and facial injuries following a fist fight. Examination on admission reveals an unconscious patient smelling strongly of alcohol. He is rousable with painful stimuli, but confused and unco-operative. His pupils are unequal, with the left pupil measuring approximately 8 mm and the right 4 mm. The left pupil is unreactive to both direct and consensual light stimulus, whereas the right pupil constricts normally to direct and consensual light stimulus.
Which cranial nerve(s) is this lesion affecting?

MSFinals-3165

A 20-year-old man comes to the clinic complaining of intense headache, fever, and right periorbital pain. He has a sizable infected lesion on his face next to his right nostril, which he admits to causing by picking at an acne spot. During the physical examination, the doctor notices swelling around his right eye. The physician suspects that he may have cavernous venous sinus thrombosis (CST).
What is a characteristic of CST?

MSFinals-3166

A 28-year-old pregnant woman is recuperating from cavernous venous sinus thrombosis. The wall of the sinus has impacted all nerves passing through it.
What is the most prominent clinical indication of cranial nerve impairment caused by this pathological condition?

MSFinals-3169

A 70-year-old man with a history of cardiovascular disease presents with vertigo, difficulty swallowing, and unsteadiness of gait. Upon neurological assessment, he is found to have nystagmus with the quick phase towards the right side and ataxia of the right upper and lower limbs. He reports no hearing loss. There is a loss of pain and temperature sensation on the right side of the face, and the left side of the limbs and trunk. The patient exhibits drooping of the right side of the palate upon eliciting the gag reflex, as well as right-sided ptosis and miosis.

Which vessel is most likely to be affected by thromboembolism given these clinical findings?

MSFinals-3170

A middle-aged student is performing a dissection of the intracranial contents. She removes the cranial cap and meninges, mobilises the brain and cuts the spinal cord just below the foramen magnum to remove the brain from the cranial cavity. On inspection of the brainstem, she notes that there are a number of nerves emerging from the brainstem.
Which of the following is true of the emergence of the cranial nerves?