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Question 1
Incorrect
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A 45-year-old male, came to the OPD with a complaint of severe headache on the right side with right-sided jaw pain and additional blurred vision in the right eye. The headache was throbbing in character. What is the single most appropriate investigation?
Your Answer: CT head
Correct Answer: ESR
Explanation:The age of the patient, one sided headache and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.
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This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer: Blepharospasm - Progressive supra-nuclear palsy
Correct Answer: Facial synkinesis - Wilson's disease
Explanation:Wilson’s disease may have an asymmetric tremor which is variable in character and may be predominantly resting, postural, or kinetic.
Progressive supra-nuclear palsy – blepharospasm, apraxia of lid opening and/or apraxia of lid closing.
Tourette’s syndrome – one or more motor or vocal tics.
Multiple Sclerosis – continuous facial myokymia.
Tardive dyskinesia is a side-effect of conventional antipsychotics, neuroleptics, anticholinergics, and toxins resulting in stiff, jerky movements of your face and body -
This question is part of the following fields:
- Neurology
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Question 3
Incorrect
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A 38 year old alcoholic presented with an ataxic gait, nystagmus and confusion. What is the most likely clinical diagnosis?
Your Answer: Korsakoff’s syndrome
Correct Answer: Wernicke’s encephalopathy
Explanation:Wernicke’s encephalopathy is a clinical triad of encephalopathy, gait ataxia and nystagmus.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A 61-year-old man presented with a TIA and loss of consciousness for 30 min. His CT brain scan is normal and his ECG shows atrial fibrillation. Which risk assessment score is best used in this case?
Your Answer: MEWS
Correct Answer: CHADS2
Explanation:CHADS2 score provides a comprehensive prediction of thromboembolic events in avalvular AF patients:
C Congestive heart failure – 1
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) – 1
A Age ≥75 years – 1
D Diabetes mellitus – 1
S2 Prior Stroke or TIA or Thromboembolism – 2 -
This question is part of the following fields:
- Neurology
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Question 5
Incorrect
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A 32 year old female has had an episode of a severe occipital headache. This is accompanied by vomiting and unconsciousness. She has been taken to the emergency department, where she is conscious and completely alert. Her pulse is normal and no abnormal neurological signs are found. From the list of options, choose the next step in her treatment.
Your Answer: MRI head
Correct Answer: CT brain
Explanation:Severe headaches and LOC can be caused by basilar migraines (but here the patient has no neurological deficit and becomes completely alert when recovering from unconscious periods). In order to diagnose basilar migraines, there needs to be a history of at least two other migraine attacks with an aura. The diagnostic criteria of a basilar migraine are not fulfilled and so the patient must not be discharged without a CT scan (or MRI).
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This question is part of the following fields:
- Neurology
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Question 6
Incorrect
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A 51-year-old woman complains of sudden onset of severe headache and vomiting that is worse when she is lying flat. Fundoscopy confirms bilateral papilledema. Which is the definitive investigation in this case?
Your Answer: Magnetic resonance imaging
Correct Answer: Computed tomography scan
Explanation:A head CT scan is the best step to rule out a mass lesion or bleed. Since the patient has symptoms that may suggest elevated intracranial pressure (ICP), a lumbar puncture should be consulted first with a neurologist since it is contraindicated in this case due to raised ICP and risk of coning.
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This question is part of the following fields:
- Neurology
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Question 7
Incorrect
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A 34 year male is brought to the emergency by the paramedics who found him unconscious after being hit by a car. However, he regained consciousness and began talking. While waiting for the doctor's review, he suddenly becomes comatose and the condition deteriorates. What will be the most likely diagnosis?
Your Answer: Intracerebral haemorrhage
Correct Answer: Extradural haemorrhage
Explanation:Extradural haemorrhage occurs as a result of head trauma and subsequent acute haemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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A 12 year old female presents at her local emergency room with a complete loss of consciousness, intercostal retractions, no residual sign and no post-ictal phase. She later went on to have a full recovery. From the list of options, choose the most probable diagnosis.
Your Answer: Atonic seizure
Correct Answer: Partial generalized seizure
Explanation:The symptoms of a partial generalized seizure are consistent with this patient.
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This question is part of the following fields:
- Neurology
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Question 9
Incorrect
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A 60-year-old male presented in OPD with a complaint of inability to walk properly because of his left foot. History reveals he has undergone left knee surgery to for severe arthritis. On examination, dorsiflexion of his left foot was found to be compromised, and sensation over the dorsum of his left foot was impaired. Which of the following conditions is this man most likely suffering from?
Your Answer: Rupture of Achilles tendon
Correct Answer: Compression of common peroneal nerve
Explanation:The branches of the common peroneal nerve innervate the skin of the dorsum of the foot as well as the muscles which help to carry out dorsiflexion of the foot. Compression of the common peroneal nerve cause foot drop as well as the loss in sensation of the skin on the dorsum of the foot.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A 52-year-old hypertensive, smoker presents to ER with right side weakness. He gives a history of multiple falls and lack of concentration. What is the most appropriate diagnosis?
Your Answer: Shy-drager syndrome
Correct Answer: Multi-infarct dementia
Explanation:The patient is a heavy smoker and hypertensive which are risk factors of atherosclerosis and cerebrovascular diseases. The acute onset of the weakness and the lateralization indicates a cerebral infarction.
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This question is part of the following fields:
- Neurology
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Question 11
Incorrect
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A 61 year old woman with a history of fluent dysphasia is brought by her husband because she's no longer able to understand instructions. Which is the most probable site of arterial occlusion?
Your Answer: Superior division of middle cerebral artery (dominant hemisphere)
Correct Answer: Inferior division of middle cerebral artery (dominant hemisphere)
Explanation:The condition described is called Wernicke’s aphasia and is the result of occlusion of the inferior division of the middle cerebral artery. This type of aphasia is classified as fluent aphasia in which understanding is impaired.
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This question is part of the following fields:
- Neurology
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Question 12
Incorrect
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A 50-year-old female was examined after complaining of weak limbs. It was discovered she had burn marks on her fingers, diminished reflexes, and wasted and weak hands. Additionally, she has dissociated sensory loss and weak spastic legs. What is the diagnosis for this patient?
Your Answer: Motor neuron disease
Correct Answer: Syringomyelia
Explanation:All of the symptoms experienced by this patient are consistent with Syringomyelia. The sensory features are as follows: loss of temperature and pain sensation; sensory loss in the arms, shoulders, and upper body; touch, vibration, and position senses are affected in the feet as the syrinx enlarges into the dorsal column. Motor features are as follows: muscle wasting and weakness which begins in the hand, and moves onto the forearms and shoulders; loss of tendon reflexes. Autonomic involvement, such as the bladder and bowel, can occur.
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This question is part of the following fields:
- Neurology
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Question 13
Correct
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A 22 year old patient was diagnosed with glioblastoma multiforme, after he was investigated for seizures. The cell of origin of this tumour is?
Your Answer: Astrocytes
Explanation:Glioblastoma multiforme is the most common anaplastic malignant tumour of the glial cells. It is a mixture of poorly differentiated anaplastic astrocytes.
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?
Your Answer: A blood neutrophil leucocytosis
Correct Answer: A family history of polycystic renal disease
Explanation:Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.
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This question is part of the following fields:
- Neurology
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Question 15
Incorrect
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A 51 year old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?
Your Answer:
Correct Answer: Magnetic resonance imaging (MRI)
Explanation:A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.
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This question is part of the following fields:
- Neurology
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Question 16
Incorrect
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A 68 year old male presented with unbalances and vomiting for 1 week. Which of the following is the best investigations that can be performed to arrive at a diagnosis?
Your Answer:
Correct Answer: MRI of Cerebellum
Explanation:Lesions in cerebellum and pontine region should be excluded. So the most appropriate investigation is MRI of cerebellum.
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This question is part of the following fields:
- Neurology
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Question 17
Incorrect
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A 22 year old male presented with a cut injury at his wrist. Which of the following would be the expected clinical signs if his ulnar nerve was damaged?
Your Answer:
Correct Answer: Wasting of the interossei
Explanation:Damage to the ulnar nerve at wrist will cause wasting of the interossei and adductor pollicis muscle. There won’t be any sensory loss, weakness of wrist flexion or wasting of hypothenar muscles.
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This question is part of the following fields:
- Neurology
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Question 18
Incorrect
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer:
Correct Answer: Evidence demyelination on nerve conduction studies
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Neurology
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Question 19
Incorrect
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An 18 year old, previously well boy was admitted following a generalized tonic-clonic convulsion for 5 minutes with urinary incontinence and eye rolling. On examination, he was drowsy and had bilateral up going plantar reflexes. A short while ago he had been playing rugby and had taken a hit to the head. He was apparently normal for a few minutes before fitting. His blood sugar level was normal. Which of the following is the most probable reason for this presentation?
Your Answer:
Correct Answer: Post-traumatic seizure
Explanation:The history is suggestive of a post-traumatic seizure which frequently occurs after moderate or severe traumatic brain injury. Although upgoing plantars can be identified in a post-ictal status, an intracranial bleed has to be excluded. A single seizure cannot be considered epilepsy
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This question is part of the following fields:
- Neurology
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Question 20
Incorrect
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A 65-year-old female presented with episodes of unilateral blindness, which spontaneously resolved. Her cardiovascular examination was normal. What is the single most appropriate investigation that can be performed to arrive at a diagnosis?
Your Answer:
Correct Answer: Carotid duplex ultrasonography
Explanation:Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour, which is the screening test of choice to evaluate for carotid stenosis.
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This question is part of the following fields:
- Neurology
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Question 21
Incorrect
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A 7-year-old boy was brought to the ED in an unconscious and apnoeic state. What is your immediate management of this case?
Your Answer:
Correct Answer: Secure airway
Explanation:ABC : Airway, breathing, circulation is the order of assessment in any patient that is unconscious and apnoeic.
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This question is part of the following fields:
- Neurology
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Question 22
Incorrect
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A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer:
Correct Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
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This question is part of the following fields:
- Neurology
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Question 23
Incorrect
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A young woman presents to the emergency after being involved in a fight where she was stabbed in the neck. On examination, her tongue deviates to the right side on protrusion. Which of the following nerves is involved?
Your Answer:
Correct Answer: Hypoglossal nerve injury
Explanation:The motor functions of the intrinsic tongue muscles, as well as the genioglossus, hyoglossus, and styloglossus muscles, are all innervated by the hypoglossal nerve. These muscles are essential for swallowing and speech. To test nerve function, the physical examiner has a patient protrude his or her tongue. In intranuclear, or lower motor neuron lesions, the tongue deviates toward the injured side, as the contralateral genioglossus is acting unopposed. In contrast, supranuclear (upper motor neuron) lesions result in deviation away from the lesion. In addition to causing deviation toward the lesion, an injury involving a hypoglossal nucleus may result in tongue atrophy and fasciculation
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This question is part of the following fields:
- Neurology
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Question 24
Incorrect
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A 51 year old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer:
Correct Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
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This question is part of the following fields:
- Neurology
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Question 25
Incorrect
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A 67 year old male presented with a history of chronic backache and altered sensation over the lateral side of his right calf and foot. Which of the following nerve roots will most likely be involved in this patient?
Your Answer:
Correct Answer: L5-S1
Explanation:Lesions in L5-S1 region leads to altered sensation on the lateral side of calf and foot, along with back pain. There might be difficulty in extension of the leg, foot inversion, plantar flexion and toe flexion, as muscles controlling these functions are supplied by S1.
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This question is part of the following fields:
- Neurology
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Question 26
Incorrect
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A 44 year old alcoholic man was operated on for a strangulated abdominal hernia, however a few days after the operation he became agitated. According to the patient, he used to see snakes curling over his body. O/E he was agitated, tachycardiac and confused. The most likely diagnosis would be?
Your Answer:
Correct Answer: Delirium tremens
Explanation:Delirium tremens occurs due to alcohol withdrawal and presents clinically with hallucinations, agitations, confusion and hyperthermia. Wernicke’s encephalopathy is characterised by encephalopathy, oculomotor dysfunction and ataxic gait. In Korsakoff’s syndrome, there is marked short term memory loss, however the long term memory is preserved & the sensorium is also intact.
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This question is part of the following fields:
- Neurology
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Question 27
Incorrect
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A 68 year old woman with contralateral hemisensory loss presents with severe burning pain in this area. In which of the following areas has arterial occlusion most probably occurred?
Your Answer:
Correct Answer: Thalamogeniculate artery
Explanation:The woman’s clinical evolution suggests that there was a thalamic stroke in the contralateral hemisphere. The artery most likely affected is the thalamogeniculate artery. Sensory loss is usually unilateral and presents at the opposite side of the brain lesion. This kind of stroke can result in severe burning pain which is responsive to tricyclics.
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 30-year-old patient has ataxia, nystagmus and vertigo with a history of headaches. Where is the most likely site of the lesion?
Your Answer:
Correct Answer: Cerebellum
Explanation:Damage to the cerebellum can cause asynergia, dysmetria, adiadochokinesia, intention tremor, staggering, ataxic gait, tendency toward falling, hypotonia, ataxic dysarthria and nystagmus.
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This question is part of the following fields:
- Neurology
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Question 29
Incorrect
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When considering the anatomical location of intracranial meningiomas, which of the following relations is well recognised?
Your Answer:
Correct Answer: Parasagittal - spastic paraparesis
Explanation:The localisation of intracranial lesions (based on both history and examination) is crucial. Meningiomas are slow in growth, and its subtle effects are very different from the more aggressive, intrinsic lesions. Olfactory groove lesions affect the sense of smell and may produce ipsilateral optic atrophy. Sphenoid ridge lesions will produce exophthalmos. Chiasmal lesions usually produce bitemporal hemianopia.
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This question is part of the following fields:
- Neurology
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Question 30
Incorrect
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A drunken man has fallen asleep in a position with his arm hanging down. After waking up he complained of wrist drop and sensory loss at the web of the thumb. Which of the following structures is most likely to be affected?
Your Answer:
Correct Answer: Radial nerve
Explanation:This presentation is known as ‘Saturday night palsy’. When someone falls asleep with a arm hanging over the arm rest of a chair, the radial nerve compresses and causes wrist drop and loss of sensation at the web of the thumb.
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This question is part of the following fields:
- Neurology
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