A 50-year-old truck driver is admitted with a left-sided facial droop, dysphasia and dysarthria. His symptoms slowly improve and he is very eager to return to work as he is self-employed. After 3 weeks, he has made a complete clinical recovery and neurological examination is normal. As per the guidelines of the Driver and Vehicle Licensing Agency (DVLA), when can he recommence driving his truck?
An 85-year-old man with a history of hypertension, hyperlipidemia, and smoking presents to the Emergency Department with left-sided weakness and numbness. On examination, he has a drooping left face, decreased strength in his left arm and leg (4/5), and reduced sensation on the left side of his body. His pulse is regular at 70 bpm, and his blood pressure is 180/100 mmHg. The initial diagnosis is a possible ischemic stroke.
What proportion of strokes are ischemic rather than hemorrhagic?
A 35-year-old motorcyclist was brought to the Emergency Department after being in a road traffic accident and found alone on the road. Upon examination, he seems drowsy and is making grunting sounds, his pupils are equal and reactive to light, his eyes open to pain, and he withdraws his hand when the nurses attempt to insert a cannula. What is his Glasgow Coma Scale (GCS) score?
A middle-aged man is brought into the Emergency Department in an unresponsive state. He was found lying in the street by a passer-by who called the ambulance. Upon initial assessment, he is not communicating with you meaningfully, only muttering swear words occasionally. He is not responding to commands but reaches up to push your hand away when you squeeze his trapezius muscle. When you do this, he does not open his eyes.
What is this patient’s Glasgow Coma Score (GCS)?
A 20-year-old man complained of a sudden frontal headache accompanied by photophobia. He also experienced neck stiffness and had a temperature of 38°C. What distinguishing feature would indicate a diagnosis of subarachnoid haemorrhage instead of bacterial meningitis?
What is a lower motor neurone lesion associated with?
A 26-year-old woman comes to the Emergency Department complaining of a headache and fever. During the examination, you observe that she is wearing sunglasses due to the bright lights worsening her headache. Kernig’s sign is positive, and you suspect meningitis. Which of the following statements regarding the cranial meninges is accurate?
What is the most optimal choice for establishing a permanent entry point for haemodialysis treatment?
A 67-year-old woman presents to her GP with a four month history of general malaise, weight loss, night sweats and fevers.
Examination shows a non-blanching rash across her lower legs, feet and hands. She has mild widespread wheeze and a systolic murmur consistent with her known COPD and aortic stenosis.
Temperature is 38°C, BP 150/100 mmHg. Urine dipstick is positive for blood and protein. Bloods show a raised creatinine at 140 umol/l, CRP of 230 mg/l, ESR of 45 mm/hr, with mild anaemia and mild leucocytosis. Her autoimmune screen is pending.
She is admitted for further investigation. What would be the next investigation of choice?
As a GP, you examine a 28-year-old pregnant woman who complains of mild ankle swelling. She denies any symptoms of a urinary tract infection. Upon conducting a urinalysis, the following results are obtained:
Haemoglobin: Negative
Urobilinogen: Negative
Bilirubin: Negative
Protein: ++
Glucose: ++
Nitrites: Negative
Leucocytes: ++
Ketones: Negative
What could be the possible explanation for these findings?