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  • Question 1 - A 55-year-old man has been referred to you due to a personality change...

    Correct

    • A 55-year-old man has been referred to you due to a personality change that has been going on for a year. He has become loud, sexually flirtatious, and inappropriate in social situations. He has also been experiencing difficulties with memory and abstract thinking, but his arithmetic ability remains intact. There is no motor impairment, and his speech is relatively preserved. Which area of the brain is most likely affected?

      Your Answer: Frontal lobe

      Explanation:

      Pick’s Disease: A Rare Form of Dementia

      Pick’s disease is a type of dementia that is not commonly seen. It is characterized by the degeneration of the frontal and temporal lobes of the brain. The symptoms of this disease depend on the location of the lobar atrophy, with patients experiencing either frontal or temporal lobe syndromes. Those with frontal atrophy may exhibit early personality changes, while those with temporal lobe atrophy may experience aphasia and semantic memory impairment.

      Pathologically, Pick’s disease is associated with Pick bodies, which are inclusion bodies found in the neuronal cytoplasm. These bodies are argyrophilic, meaning they have an affinity for silver staining. Unlike Alzheimer’s disease, EEG readings for Pick’s disease are relatively normal.

      To learn more about Pick’s disease, the National Institute of Neurological Disorders and Stroke provides an information page on frontotemporal dementia. this rare form of dementia can help individuals and their loved ones better manage the symptoms and seek appropriate treatment.

    • This question is part of the following fields:

      • Neurology
      11.5
      Seconds
  • Question 2 - Which statement about the facial nerve is accurate in terms of its paragraph...

    Correct

    • Which statement about the facial nerve is accurate in terms of its paragraph structure?

      Your Answer: Is secretomotor to the lacrimal gland

      Explanation:

      Functions of the Facial Nerve

      The facial nerve, also known as the seventh cranial nerve, has several important functions. It carries secretomotor fibers to the lacrimal gland through the greater petrosal nerve and is secretomotor to the submandibular and sublingual glands. It also supplies the muscles of facial expression and is associated developmentally with the second branchial arch. The facial nerve carries special taste sensation to the anterior two-thirds of the tongue via the chorda tympani nerve and somatic sensation to the external auditory meatus. However, it does not innervate the levator palpebrae superioris or the principal muscles of mastication, which are supplied by other nerves.

    • This question is part of the following fields:

      • Neurology
      44.4
      Seconds
  • Question 3 - A 75-year-old retired teacher presents with acute-onset confusion. The patient lives alone and...

    Correct

    • A 75-year-old retired teacher presents with acute-onset confusion. The patient lives alone and is usually in good health. She has had no issues with her memory before, but over the past three days, her neighbor has noticed that the patient has become increasingly confused; this morning she did not recognize her own home. When taking the history from the neighbor, she mentions that the patient had been experiencing urinary symptoms over the past week. A dipstick of the patient’s urine is positive for blood, leukocytes and nitrites. A tentative diagnosis of delirium secondary to a urinary tract infection (UTI) is made, and empirical treatment for UTI is initiated.
      Which of the following tests is typically abnormal during delirium, regardless of the cause?

      Your Answer: Electroencephalogram

      Explanation:

      Diagnostic Tests for Delirium: Understanding Their Role in Evaluation

      Delirium is a state of acute brain impairment that can be caused by various factors. The diagnosis of delirium is based on clinical features, such as acute onset, fluctuating course, disorientation, perceptual disturbances, and decreased attention. However, diagnostic tests may be necessary to identify the underlying cause of delirium and guide appropriate treatment. Here are some common diagnostic tests used in the evaluation of delirium:

      Electroencephalogram (EEG): EEG can show diffuse slowing in delirious individuals, regardless of the cause of delirium. A specific pattern called K complexes may occur in delirium due to hepatic encephalopathy.

      Lumbar puncture: This test may be used to diagnose meningitis, which can present with delirium. However, it may not be abnormal in many cases of delirium.

      Serum glucose: Hyper- or hypoglycemia can cause delirium, but serum glucose may not be universally abnormal in all cases of delirium.

      Computed tomography (CT) of the head: CT may be used to evaluate delirium, but it may be normal in certain cases, such as profound sepsis causing delirium.

      Electrocardiogram (ECG): ECG is unlikely to be abnormal in delirium, regardless of the cause.

      While diagnostic tests can be helpful in the evaluation of delirium, the cornerstone of treatment is addressing the underlying cause. Patients with delirium need close monitoring to prevent harm to themselves. Manipulating the environment, using medications to reduce agitation and sedate patients, and providing reassurance and familiar contact can also be helpful in managing delirium.

    • This question is part of the following fields:

      • Neurology
      5.9
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  • Question 4 - A 45-year-old woman with a history of schizophrenia resulting in multiple hospitalisations is...

    Correct

    • A 45-year-old woman with a history of schizophrenia resulting in multiple hospitalisations is referred to you in a psychiatry ward. She reports feeling generally unwell for several weeks, with increasing stiffness in her jaws and arms. She has been on haloperidol for the past few years with good symptom control. During examination, her temperature is 38.5°C and BP is 175/85 mmHg. What drug treatments would you consider for her condition?

      Your Answer: Dantrolene

      Explanation:

      Neuroleptic Malignant Syndrome vs Serotonin Syndrome

      Neuroleptic malignant syndrome (NMS) is a potential side effect of antipsychotic medications that can occur at any point during treatment. Concurrent use of lithium or anticholinergics may increase the risk of NMS. Symptoms include fever, rigidity, altered mental status, and autonomic dysfunction. Treatment involves discontinuing the offending medication and using antipyretics to reduce body temperature. Dantrolene, bromocriptine, or levodopa preparations may also be helpful.

      Serotonin syndrome is a differential diagnosis for NMS, but the two can be distinguished through a thorough history and examination. NMS develops over days and weeks, while serotonin syndrome can develop within 24 hours. Serotonin syndrome causes neuromuscular hyperreactivity, such as myoclonus, tremors, and hyperreflexia, while NMS involves sluggish neuromuscular response, such as bradyreflexia and rigidity. Hyperreflexia and myoclonus are rare in NMS, and resolution of NMS takes up to nine days, while serotonin syndrome usually resolves within 24 hours.

      Despite these differences, both conditions share common symptoms in severe cases, such as hyperthermia, muscle rigidity, leukocytosis, elevated CK, altered hepatic function, and metabolic acidosis. Therefore, a thorough history and physical examination are crucial in distinguishing between the two syndromes.

    • This question is part of the following fields:

      • Neurology
      9.2
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  • Question 5 - A 20-year-old woman arrives at the Emergency Department complaining of fever, headache, and...

    Correct

    • A 20-year-old woman arrives at the Emergency Department complaining of fever, headache, and feeling generally unwell for the past two days. She denies having a rash, neck stiffness, photophobia, or vomiting. Her vital signs are within normal limits. The medical team suspects she may have viral encephalitis and orders a computed tomography head scan and lumbar puncture for cerebrospinal fluid (CSF) analysis.

      The initial CSF results confirm the suspected diagnosis, showing a normal opening pressure and CSF glucose level, with a slightly elevated white cell count, mostly lymphocytes, and a protein level of 0.6 g/l (normal value < 0.45 g/l). While waiting for the CSF culture results, what is the most appropriate management for this 20-year-old woman?

      Your Answer: acyclovir

      Explanation:

      Treatment Options for Suspected Encephalitis or Meningitis

      Encephalitis is a condition where the brain parenchyma is infected, while meningitis is characterized by inflammation of the meninges. A patient with symptoms of fever, headache, and altered mental state may have viral encephalitis, which is commonly caused by herpes simplex virus type I. In such cases, acyclovir should be started immediately, as it has been proven to improve morbidity and mortality. On the other hand, empirical ceftriaxone is often used for suspected bacterial meningitis, while benzylpenicillin is recommended for patients with a non-blanching rash. Dexamethasone is used to reduce inflammation in certain cases of bacterial meningitis. However, supportive management alone with analgesia is not appropriate for suspected encephalitis or meningitis. It is important to consider the patient’s symptoms and initial CSF results before deciding on the appropriate treatment option.

    • This question is part of the following fields:

      • Neurology
      33.1
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  • Question 6 - A 5-year-old boy is brought to his General Practitioner as his parents are...

    Correct

    • A 5-year-old boy is brought to his General Practitioner as his parents are worried about his walking. Up until four months ago, he was developing normally. However, they have now noticed he has difficulty getting up from the floor or climbing stairs. During the examination, the doctor observes Gowers’ sign and the boy has large, bulky calf muscles. His mother remembers having an uncle who died at a young age but cannot recall the cause of death. What is the probable reason for his walking difficulties?

      Your Answer: Duchenne muscular dystrophy

      Explanation:

      Different Types of Muscular Dystrophy and their Characteristics

      Muscular dystrophy is a group of genetic disorders that cause progressive muscle weakness and wasting. Here are some of the different types of muscular dystrophy and their characteristics:

      1. Duchenne muscular dystrophy: This is an X-linked myopathy that occurs in boys aged 3-5. It can present as delay in motor development or regression of previously obtained motor milestones. Treatment is with steroids and respiratory support. Average life expectancy is around 25 years.

      2. Facioscapulohumeral dystrophy: This is the third most common muscular dystrophy and causes proximal upper limb weakness due to dysfunction of the scapula. Patients may also experience facial muscle weakness and progressive lower limb weakness. It typically presents in the third decade.

      3. Emery-Dreifuss muscular dystrophy: This is a rare muscular dystrophy characterised by weakness and progressive wasting of the lower leg and arm muscles. It is more common in boys, with typical onset in teenage years.

      4. Myotonic dystrophy: This is the most common inherited muscular dystrophy in adults. It is characterised by delayed muscle relaxation after contraction and muscle weakness. Patients may also experience myotonic facies with facial weakness, ptosis and cardiorespiratory complications.

      5. Polymyositis: This is an inflammatory myopathy in which patients experience proximal muscle weakness. It is more common in women in the fifth decade and is associated with underlying malignancy.

      It is important to identify the type of muscular dystrophy a patient has in order to provide appropriate treatment and management.

    • This question is part of the following fields:

      • Neurology
      19.2
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  • Question 7 - A 25-year-old, fit and healthy woman develops severe headache, confusion and nausea on...

    Incorrect

    • A 25-year-old, fit and healthy woman develops severe headache, confusion and nausea on day 5 of climbing Mount Kilimanjaro in her adventure trip. A doctor accompanying the group examines her and finds her to be tachycardic with a raised temperature. They diagnose high-altitude cerebral oedema.
      What is the most crucial step in managing this patient?

      Your Answer: Dexamethasone

      Correct Answer: Descent

      Explanation:

      Treatment of High-Altitude Cerebral Oedema: The Importance of Rapid Descent

      High-altitude cerebral oedema is a serious medical emergency that can be fatal if not treated promptly. It is caused by swelling of the brain at high altitudes and requires immediate action. The most important management for this condition is rapid descent to lower altitudes. In severe cases, patients may need to be air-lifted or carried down as their symptoms prevent them from doing so themselves. While oxygen and steroids like dexamethasone can help improve symptoms, they are secondary to descent.

      Acetazolamide is a medication that can be used to prevent acute mountain sickness, but it is not effective in treating high-altitude cerebral oedema. Oxygen can also help reduce symptoms, but it is not a substitute for rapid descent.

      Rest is important in preventing acute mountain sickness, but it is not appropriate for a patient with high-altitude cerebral oedema. Adequate time for acclimatisation and following the principles of climb high, sleep low can reduce the risk of developing symptoms.

      In summary, rapid descent is the most important treatment for high-altitude cerebral oedema. Other interventions like oxygen and steroids can be helpful, but they are not a substitute for immediate action.

    • This question is part of the following fields:

      • Neurology
      14.8
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  • Question 8 - A 65-year-old woman presents with a history of facial pain and diplopia. Clinical...

    Incorrect

    • A 65-year-old woman presents with a history of facial pain and diplopia. Clinical examination reveals CN III, CN IV and CN VI palsies, a Horner’s syndrome, and facial sensory loss in the distribution of the V1 (ophthalmic) and V2 (maxillary) divisions of the trigeminal cranial nerve.
      Where is the causative abnormality located?

      Your Answer: Inferior orbital fissure

      Correct Answer: Cavernous sinus

      Explanation:

      Anatomy of Cranial Nerves and the Cavernous Sinus

      The cavernous sinus is a crucial location for several cranial nerves and blood vessels. Cranial nerves III, IV, and VI, as well as the ophthalmic (V1) and maxillary (V2) divisions of the V cranial nerve, pass through the cavernous sinus with the internal carotid artery. The V2 division of the trigeminal nerve exits via the foramen rotundum, while the rest of the cranial nerves enter the orbit through the superior orbital fissure.

      Damage to these nerves can result in ophthalmoplegia, facial pain, and sensory loss. Involvement of sympathetic nerves around the internal carotid artery can lead to Horner’s syndrome. Tolosa Hunt syndrome is an idiopathic inflammatory process that affects the cavernous sinus and can cause a cluster of these symptoms.

      Dorello’s canal carries cranial nerve VI (abducens) from the pontine cistern to the cavernous sinus. The zygomatic branch of the maxillary division of the trigeminal nerve passes through the inferior orbital fissure. Meckel’s cave houses the trigeminal nerve ganglion.

    • This question is part of the following fields:

      • Neurology
      49.1
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  • Question 9 - You see a 92-year-old lady in clinic. Over the past 3 months, her...

    Incorrect

    • You see a 92-year-old lady in clinic. Over the past 3 months, her family believes she is becoming more forgetful. She has also noticed a tremor in her right hand and is generally ‘slowing down’. She takes amlodipine for hypertension and a daily aspirin of her own volition. She has recently been treated for a urinary tract infection by her general practitioner. She also complains of confusion and seeing spiders climbing the walls of her bedroom. She has no other urinary complaints. Her abbreviated mental test score is 5/10. Lying and standing blood pressures are 138/76 and 127/70, respectively.
      Select the most likely diagnosis from the list below.

      Your Answer: Parkinson's disease

      Correct Answer: Lewy body dementia (LBD)

      Explanation:

      Distinguishing between Dementia Types: Lewy Body Dementia, Parkinson’s Disease, Alzheimer’s Disease, Vascular Dementia, and Multisystem Atrophy

      Dementia is a complex condition that can have various underlying causes. Lewy body dementia (LBD) is a type of dementia that is characterized by cognitive impairment, parkinsonism, visual hallucinations, rapid eye movement (REM) sleep disorders, and autonomic disturbance. Treatment for LBD focuses on symptom management, including the use of cholinesterase inhibitors and antidepressants.

      Parkinson’s disease, on the other hand, typically presents with bradykinesia, tremor, and rigidity, but not cognitive impairment in the initial stages. Autonomic dysfunction is also expected in Parkinson’s disease, which is not evident in the given case. Alzheimer’s disease may cause forgetfulness and slowing down, but visual hallucinations are not typical. Vascular dementia usually presents with a stepwise deterioration that correlates with small cerebrovascular events, but not visual hallucinations. Multisystem atrophy is a rare condition characterized by parkinsonism with autonomic dysfunction, but it is less likely in this case due to the lack of orthostatic hypotension.

      Therefore, distinguishing between different types of dementia is crucial for accurate diagnosis and appropriate treatment.

    • This question is part of the following fields:

      • Neurology
      75.4
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  • Question 10 - A 70-year-old hypertensive, diabetic smoker presents with sudden onset unilateral facial weakness, hemiparesis...

    Incorrect

    • A 70-year-old hypertensive, diabetic smoker presents with sudden onset unilateral facial weakness, hemiparesis of the upper and lower limbs and sensory disturbance. All symptoms are on the same side. Global aphasia is also noted on examination. CT brain is normal. An ischaemic cerebrovascular accident (CVA) is diagnosed.
      What is the most likely vascular territory involved?

      Your Answer: Right middle cerebral artery

      Correct Answer: Left middle cerebral artery

      Explanation:

      Understanding the Different Types of Stroke and Their Symptoms

      Strokes can occur when there is a blockage or rupture of blood vessels in the brain, leading to a lack of oxygen and nutrients to brain cells. Different types of strokes can affect different areas of the brain, resulting in varying symptoms. Here are some examples:

      – Left middle cerebral artery: This type of stroke can cause unilateral facial weakness, hemiplegia, and hemisensory loss. It can also lead to global aphasia, which is a language impairment that affects the dominant hemisphere of the brain (usually the left side). This occurs when the trunk of the left MCA is occluded, causing damage to Broca’s and Wernicke’s areas in the left perisylvian cortex.
      – Right middle cerebral artery: A stroke in the right MCA can cause contralateral motor and sensory symptoms without speech disturbance.
      – Basilar artery: This type of stroke can be particularly devastating, as it affects the brainstem and can lead to a locked-in state. Prognosis is poor.
      – Right internal carotid artery: This is typically asymptomatic, as collateral circulation from the circle of Willis can compensate for the occlusion.
      – Left vertebral artery: A stroke in the left vertebral artery can cause posterior circulation stroke, which can result in symptoms such as nausea, vomiting, gait disturbance, and vertigo.

      It’s important to recognize the symptoms of a stroke and seek medical attention immediately. Time is of the essence when it comes to treating strokes, as early intervention can help minimize damage to the brain.

    • This question is part of the following fields:

      • Neurology
      11.3
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  • Question 11 - A 19-year-old male has recently been diagnosed with schizophrenia. He was prescribed haloperidol,...

    Incorrect

    • A 19-year-old male has recently been diagnosed with schizophrenia. He was prescribed haloperidol, but after two weeks, he was discovered to be confused and drowsy. Upon examination, he was found to have a fever of 40.7°C, rigid muscles, and a blood pressure of 200/100 mmHg. What treatment would you recommend in this situation?

      Your Answer: Diazepam

      Correct Answer: Dantrolene

      Explanation:

      Neuroleptic Malignant Syndrome

      Neuroleptic malignant syndrome (NMS) is a serious medical condition that is commonly caused by potent neuroleptics. Its major features include rigidity, altered mental state, autonomic dysfunction, fever, and high creatinine kinase. The condition can lead to potential complications such as rhabdomyolysis and acute renal failure.

      The treatment of choice for NMS is dantrolene and bromocriptine. However, withdrawal of neuroleptic treatment is mandatory to prevent further complications. It is important to note that NMS can be life-threatening and requires immediate medical attention. Therefore, it is crucial to recognize the symptoms and seek medical help as soon as possible.

    • This question is part of the following fields:

      • Neurology
      37.8
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  • Question 12 - A 25-year-old law student complains that she cannot fall asleep until 0330 h....

    Correct

    • A 25-year-old law student complains that she cannot fall asleep until 0330 h. She sleeps through morning classes, frequently waking up at about 1100 h.
      What is the most likely diagnosis?

      Your Answer: Delayed sleep phase syndrome

      Explanation:

      Common Sleep Disorders and Their Symptoms

      Sleep disorders can have a significant impact on a person’s quality of life. Here are some of the most common sleep disorders and their symptoms:

      1. Delayed Sleep Phase Syndrome: This syndrome causes a person’s circadian cycle to run longer than 24 hours, leading to a tendency to fall asleep later and later.

      2. Advanced Sleep Phase Syndrome: Patients with this syndrome tend to fall asleep too early and wake up too early.

      3. Myoclonus: Nocturnal myoclonus, or periodic limb movement disorder, causes twitching or kicking of the lower extremities during sleep, leading to momentary arousals.

      4. Narcolepsy: This dyssomnia causes a person to suddenly fall asleep involuntarily at inappropriate times.

      5. Sleep Apnoea: This disorder causes a person to stop breathing during sleep, putting stress on the circulatory system.

      It’s important to seek medical attention if you suspect you have a sleep disorder.

    • This question is part of the following fields:

      • Neurology
      21.4
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  • Question 13 - A 31-year-old man visits the Neurology Clinic accompanied by his brother. He reports...

    Incorrect

    • A 31-year-old man visits the Neurology Clinic accompanied by his brother. He reports experiencing episodes of confusion and amnesia that typically last for a few minutes. His brother has observed him suddenly stopping what he is doing and staring into space on several occasions. The patient presents a video of one such episode, which shows lip-smacking and chewing. He has no recollection of these incidents, but he has noticed the smell of burning and a strange sense of déjà vu on multiple occasions. There is no indication of tongue biting or limb jerking. The patient is in good health, but he admits to regularly using cannabis. What is the most probable cause of these occurrences?

      Your Answer: Non-epileptic seizures

      Correct Answer: Temporal lobe epilepsy

      Explanation:

      Distinguishing Temporal Lobe Epilepsy from Other Seizure Disorders and Cannabis Usage

      Temporal lobe epilepsy is a neurological disorder that can manifest in various ways, including somatosensory or special sensory aura, visual hallucinations, déjà vu, manual automatisms, postictal confusion, or amnesia. The underlying causes can be diverse, such as previous infections or head trauma, and require investigation through electroencephalogram (EEG) and magnetic resonance imaging (MRI). Narcolepsy, on the other hand, is characterized by excessive daytime sleepiness, hypnagogic hallucinations, or cataplexy, and is not associated with the seizure activity typical of temporal lobe epilepsy. Absence seizures, which involve staring into space, do not feature the sensory aura or postictal confusion of temporal lobe epilepsy. Cannabis overuse may cause seizures and psychosis, but not the specific seizures described in this scenario. Non-epileptic seizures, which can have organic or psychogenic causes, may be a differential diagnosis, but the presence of classic symptoms such as sensory aura, lip-smacking, and déjà vu suggest that temporal lobe epilepsy is more likely.

    • This question is part of the following fields:

      • Neurology
      46.5
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  • Question 14 - A woman presents to Accident and Emergency with a decreased level of consciousness....

    Incorrect

    • A woman presents to Accident and Emergency with a decreased level of consciousness. Her conscious state is formally assessed. She withdraws to a painful stimulus and is mumbling incoherent words randomly, irrespective of people attempting to speak to her in conversation, and her eyes open only in response to painful stimuli.
      What is the breakdown of this patient’s Glasgow Coma Scale (GCS) score?

      Your Answer: Motor response 3/6, verbal response 3/5, eye opening response 2/4

      Correct Answer: Motor response 4/6, verbal response 3/5, eye opening response 2/4

      Explanation:

      Understanding the Glasgow Coma Scale: Interpreting a Patient’s Level of Consciousness

      The Glasgow Coma Scale (GCS) is a tool used to assess a patient’s level of consciousness. It consists of three scores: best motor response, best verbal response, and eye opening response. Each score is given a value out of a maximum score, and the total score is used to determine the patient’s level of consciousness.

      In this case, the patient’s motor response is a score of 4 out of 6, indicating a withdrawal response to pain. The verbal response is a score of 3 out of 5, indicating mumbling words or nonsense. The eye opening response is a score of 2 out of 4, indicating opening to pain. Therefore, the patient’s total GCS score is 9, indicating a comatose state.

      It is important to understand the GCS and how to interpret the scores in order to properly assess a patient’s level of consciousness and provide appropriate medical care.

    • This question is part of the following fields:

      • Neurology
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  • Question 15 - A 50-year-old man, presenting with changes in mood and behavior that have been...

    Incorrect

    • A 50-year-old man, presenting with changes in mood and behavior that have been developing over the past 8 years, is brought to the clinic by his son. The son also reports that his grandfather died from Alzheimer's disease at the age of 52. The patient has recently experienced aphasia, disorientation, and memory loss. He passes away a few weeks later. A brain biopsy shows cortical atrophy with widening of the cerebral sulci.
      What is the most probable mechanism that contributed to the development of this patient's condition?

      Your Answer: Hyper-phosphorylation of tau protein

      Correct Answer: Mutations in amyloid precursor protein

      Explanation:

      The accumulation of Aβ-amyloid in the brain is the main pathology associated with early onset familial Alzheimer’s disease. Aβ-amyloid is derived from amyloid precursor protein (APP), which is processed in two ways. The normal pathway does not result in Aβ-amyloid formation, while the abnormal pathway leads to its formation. Mutations in APP or components of γ-secretase result in an increased rate of Aβ-amyloid accumulation. In the sporadic form of the disease, SORL1 protein deficiency alters the intracellular trafficking of APP, leading to Aβ-amyloid formation. Hyper-phosphorylation of tau protein is another factor that can contribute to the onset of Alzheimer’s disease, but it is not specifically associated with early onset familial Alzheimer’s disease. Increased accumulation of amyloid light protein is also not responsible for the onset of the disease.

    • This question is part of the following fields:

      • Neurology
      27.7
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  • Question 16 - A 50-year-old man has been referred to a neurologist by his GP due...

    Incorrect

    • A 50-year-old man has been referred to a neurologist by his GP due to recent concerns with his speech. He has been experiencing difficulty verbalising his thoughts and finds this frustrating. However, there is no evidence to suggest a reduced comprehension of speech.
      He struggles to repeat sentences and well-rehearsed lists (such as months of the year and numbers from one to ten). He is also unable to name common household objects presented to him. Additionally, he constructs sentences using the incorrect tense and his grammar is poor.
      Imaging studies reveal that the issue is located in the frontotemporal region of the brain.
      What is the most likely diagnosis?

      Your Answer: Semantic dementia

      Correct Answer: Progressive non-fluent aphasia (PNFA)

      Explanation:

      Different Types of Aphasia and Their Characteristics

      Aphasia is a language disorder that affects a person’s ability to communicate effectively. There are different types of aphasia, each with its own set of characteristics. Progressive non-fluent aphasia (PNFA) primarily affects speech and language, causing poor fluency, repetition, grammar, and anomia. Wernicke’s aphasia, on the other hand, is a fluent aphasia that causes impaired comprehension and repetition, nonsensical speech, and neologisms. Broca’s aphasia is a non-fluent aphasia that affects the ability to communicate fluently, but does not affect comprehension. Semantic dementia affects semantic memory, primarily affecting naming of objects, single-word comprehension, and understanding the uses of particular objects. Finally, conductive dysphasia is caused by damage to the arcuate fasciculus, resulting in anomia and poor repetition but preserved comprehension and fluency of speech. Understanding the characteristics of each type of aphasia can help in the diagnosis and treatment of individuals with language disorders.

    • This question is part of the following fields:

      • Neurology
      39
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  • Question 17 - A 27-year-old female patient presents to the Emergency Department complaining of a severe...

    Incorrect

    • A 27-year-old female patient presents to the Emergency Department complaining of a severe headache that has been progressively worsening over the past two to three months. She also reports experiencing blurred vision. The patient has a history of depression, which she attributes to her weight problem and bad skin. However, she has been actively trying to address these issues by joining Weight Watchers and receiving treatment for her acne from her GP for the past four months. On examination, the patient is overweight and has moderately severe acne. She is afebrile, and there are no signs of nuchal rigidity. The oropharynx is benign, and the neurological examination is normal, except for blurred disc margins bilaterally and a limited ability to abduct the left eye. What is the most likely diagnosis?

      Your Answer: Migraine

      Correct Answer: Idiopathic intracranial hypertension

      Explanation:

      Idiopathic Intracranial Hypertension

      Idiopathic intracranial hypertension (IIH), previously known as benign intracranial hypertension or pseudotumour cerebri, is a condition that typically affects young obese women. Other risk factors include the use of oral contraceptive pills, treatments for acne such as tetracycline, nitrofurantoin, and retinoids, as well as hypervitaminosis A. The condition is characterized by a severe headache, loss of peripheral vision, and impaired visual acuity if papilloedema is severe. Patients may also experience a reduction in colour vision and develop a CN VI palsy.

      A CT scan is often normal, and the diagnosis is confirmed by finding an elevated CSF opening pressure of more than 20 cm H2O. CSF protein, glucose, and cell count will be normal. It is important to note that early diagnosis and treatment are crucial in preventing permanent vision loss. Therefore, if you experience any of the symptoms mentioned above, seek medical attention immediately.

    • This question is part of the following fields:

      • Neurology
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  • Question 18 - A woman is being evaluated for a chronic cranial nerve lesion in the...

    Incorrect

    • A woman is being evaluated for a chronic cranial nerve lesion in the outpatient clinic. She has no facial weakness, and examination of the eyes reveals a full range of movement. She reports no difficulties with vision, smell, taste, hearing or balance, and facial and pharyngeal sensation is normal. Her gag reflex is present and normal, and she can shrug her shoulders equally on both sides. Her speech is slurred and indistinct, and on protruding her tongue, it deviates to the right side and there is notable fasciculation and atrophy of the musculature on the right.
      With what are these findings most likely to be associated?

      Your Answer: Upper motor neurone lesion of the right cranial nerve XII

      Correct Answer: Lower motor neurone lesion of the right cranial nerve XII

      Explanation:

      Differentiating Lesions of Cranial Nerves Involved in Tongue Movement and Sensation

      Lower Motor Neurone Lesion of the Right Cranial Nerve XII:
      Fasciculation and atrophy indicate a lower motor neurone lesion. In this case, the tongue deviates to the side of the damage due to unopposed action of the genioglossus of the opposite side. The cranial nerve involved in motor supply to the muscles of the tongue is the hypoglossal cranial nerve (XII).

      Upper Motor Neurone Lesion of the Right Cranial Nerve XII:
      An upper motor neurone lesion will produce weakness and spasticity. The tongue will deviate away from the side of the damage, in this case to the left.

      Upper Motor Neurone Lesion of the Left Cranial Nerve VII:
      An upper motor neurone lesion will produce weakness and spasticity. The tongue will deviate away from the side of the damage. Even though the tongue does deviate to the right in this case, the presence of atrophy is seen in LMN and not in UMN.

      Lower Motor Neurone Lesion of the Left Cranial Nerve VII:
      This would cause lower motor neurone symptoms (weakness and flaccidity) on the left side.

      Lower Motor Neurone Lesion of the Right Glossopharyngeal Nerve:
      The glossopharyngeal nerve (cranial nerve IX) provides the posterior third of the tongue with taste and somatic sensation.

    • This question is part of the following fields:

      • Neurology
      10.1
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  • Question 19 - A 25-year-old man develops a wrist drop after suffering a spiral fracture of...

    Incorrect

    • A 25-year-old man develops a wrist drop after suffering a spiral fracture of the humerus while playing football. As a result, he is unable to extend his wrist and his hand hangs flaccidly. Which nerve is the most likely to have been damaged?

      Your Answer: Median

      Correct Answer: Radial

      Explanation:

      The brachial plexus is a network of nerves that originate from the spinal cord in the neck and supply the upper limb. Damage to these nerves can occur due to trauma or compression at various points along their course. The radial nerve, which carries fibres from C5 to C8 and a sensory component from T1, can be injured in the axilla, upper arm, elbow or wrist. A lesion at the spiral groove of the humerus can result in a wrist drop. The musculocutaneous nerve, which arises from the lateral cord of the brachial plexus, can be affected by damage to the shoulder and brachial plexus or compression by the biceps aponeurosis and tendon. The axillary nerve, which supplies the deltoid, teres minor and triceps brachii, can be injured in dislocations of the shoulder joint, compression of the axilla with a crutch or fracture of the surgical neck of the humerus. The median nerve, which innervates all of the flexors in the forearm except the flexor carpi ulnaris and that part of the flexor digitorum profundus that supplies the medial two digits, can be compressed in the carpal tunnel. The ulnar nerve, which supplies the little finger and the adjacent half of the ring finger, can be trapped in the cubital tunnel on the medial side of the elbow. Pinching of the ulnar nerve can cause paraesthesiae in the fourth and fifth digits.

    • This question is part of the following fields:

      • Neurology
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  • Question 20 - A 36-year-old man is discharged from hospital after an episode of meningitis. The...

    Incorrect

    • A 36-year-old man is discharged from hospital after an episode of meningitis. The organism was diagnosed as being Streptococcus pneumoniae after a lumbar puncture and the patient was treated with ceftriaxone. On discharge, his observations were normal. He has a past medical history of asthma treated with salbutamol and low-dose inhaled corticosteroids. He has no known drug allergies.
      A few days following his discharge, he started experiencing postural headaches that were worse when sitting upright. He grades his pain as 7/10. He has been feeling nauseated, although has had no vomiting episodes. He also has some minor neck stiffness and is not confused. He attends A&E, as he is worried about his new symptoms. There is evidence of extrathecal cerebrospinal fluid (CSF). Diagnosis is confirmed on a computed tomography (CT) myelogram.
      What is the most likely cause of this patient’s headache?

      Your Answer: Subdural haematoma

      Correct Answer: Spontaneous intracranial hypotension

      Explanation:

      Distinguishing Spontaneous Intracranial Hypotension from Other Conditions

      Spontaneous intracranial hypotension (SIH) is a condition that affects around 5 per 100,000 of the general population, with a peak age at diagnosis of 40 years. It is more common in women and develops due to a weakness in the spinal dura, which could be congenital, iatrogenic, or due to calcification of spinal discs. Lumbar punctures, which are commonly performed to aid the diagnosis of meningitis, are a common cause of SIH.

      Clinically, SIH causes a postural headache that worsens when standing or sitting and improves when lying down. It is associated with leakage of cerebrospinal fluid (CSF) and can be diagnosed with a CT myelogram. Interestingly, CSF opening pressure is often normal, making diagnosis by repeat lumbar puncture unhelpful. Treatment typically involves an epidural blood patch.

      It is important to distinguish SIH from other conditions that may present with similar symptoms. A subdural hematoma, for example, would be diagnosed on a CT head by the presence of concave opacity and typically has a slow onset with fluctuating confusion. Aseptic meningitis, which presents with symptoms similar to meningitis, would be confirmed on microscopy of lumbar puncture. Insufficiently treated meningitis would not cause a postural headache, and a subarachnoid hemorrhage would cause a sudden-onset thunderclap headache.

    • This question is part of the following fields:

      • Neurology
      46.6
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  • Question 21 - A man in his early 50s presents with a painless lump in the...

    Correct

    • A man in his early 50s presents with a painless lump in the right posterior triangle of his neck. He undergoes an excision biopsy under general anaesthetic. After the procedure, he experiences difficulty shrugging his right shoulder.
      Which nerve is most likely to have been affected during the surgery?

      Your Answer: Accessory

      Explanation:

      Nerves of the Neck: Functions and Effects of Damage

      The neck is home to several important nerves that control various muscles and sensory functions. Understanding the functions of these nerves and the effects of damage can help diagnose and treat neurological conditions.

      Accessory Nerve: This nerve supplies motor innervation to the sternocleidomastoid and trapezius muscles. Damage to this nerve can result in the inability to shrug the shoulder due to loss of innervation to the trapezius.

      Cervical Plexus: Arising deep to the sternocleidomastoid, the cervical plexus innervates the skin to the back of the head, neck, and collarbones, as well as some anterior neck muscles such as the omohyoid. Damage to this nerve would not cause issues with shoulder movement.

      Hypoglossal Nerve: The hypoglossal nerve innervates all intrinsic and extrinsic muscles of the tongue. Damage to this nerve would not cause issues with shoulder movement.

      Vagus Nerve: The vagus nerve is the longest autonomic nerve in the body and interfaces with the parasympathetic control of the heart, lungs, and gastrointestinal tract.

      Long Thoracic Nerve of Bell: This nerve innervates the serratus anterior muscle. Damage to this nerve leads to winging of the scapula but no issues with shoulder movement.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 49-year-old woman complains of weakness and difficulty breathing. These symptoms have been...

    Incorrect

    • A 49-year-old woman complains of weakness and difficulty breathing. These symptoms have been getting worse over the last three months and have now become so severe that she is unable to work. She has no history of any medical conditions.

      During the examination, the patient appears pale. The only notable finding is a strange involuntary movement of her fingers when she closes her eyes. Her blood film shows the presence of multi-lobed neutrophils.

      What clinical feature might be observed in this patient?

      Your Answer: Brisk ankle jerks

      Correct Answer: Retinal haemorrhage

      Explanation:

      Vitamin B12 Deficiency and Dorsal Column Signs

      This patient is presenting with megaloblastic anaemia and dorsal column signs, specifically pseudoathetosis due to loss of proprioceptive input from the hands. These symptoms suggest a possible vitamin B12 deficiency, which may also be indicated by the presence of multilobed neutrophils and retinal haemorrhages. While absent ankle jerks and extensor plantar reflex are common in B12 deficiency, cerebellar symptoms and hemiplegia are not typically associated with this condition. Instead, these symptoms may be indicative of multiple sclerosis, which can also present with dorsal column signs. Glossitis or beefy tongue may be present in B12 deficiency, along with other oral features like angular stomatitis or cheilitis in cases of multiple vitamin deficiencies. While retinal haemorrhage is a rare manifestation of B12 deficiency, other rare features may include optic atrophy, generalized hyperpigmentation, and dementia.

    • This question is part of the following fields:

      • Neurology
      16.1
      Seconds
  • Question 23 - A 20-year-old man arrives at the Emergency Department with an ‘ape hand’ deformity...

    Incorrect

    • A 20-year-old man arrives at the Emergency Department with an ‘ape hand’ deformity after being stabbed in his arm. Upon examination, he is found to have median nerve damage and is unable to abduct his thumb. What other function is likely to be impaired in this patient?

      Your Answer: Adduction of the fingers

      Correct Answer: Sensation to the second and third digits

      Explanation:

      Understanding Nerve Injuries: Implications for Sensation and Movement

      Nerve injuries can have significant implications for both sensation and movement. One common example is the ape hand deformity, which occurs following a median nerve injury and results in an inability to abduct the thumb. In addition to this motor deficit, the median nerve also provides sensation to the dorsal aspect of the distal first two digits, the volar aspect of the thumb, index, middle, and lateral half of the fourth digit, as well as the palm and medial aspect of the forearm.

      Other nerve injuries can affect different aspects of movement and sensation. For example, the radial nerve innervates the extensor muscles of the wrist, while the ulnar nerve provides sensation to the fifth digit and controls the palmar interossei muscles responsible for finger adduction. Abduction of the arm at the shoulder joint is controlled by the axillary nerve (deltoid muscle) and suprascapular nerve (supraspinatus muscle).

      Understanding the specific nerve involved in an injury can help clinicians predict the potential deficits a patient may experience and develop appropriate treatment plans to address them.

    • This question is part of the following fields:

      • Neurology
      24.6
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  • Question 24 - A 35-year-old man presents with a 4-month history of declining physical performance at...

    Incorrect

    • A 35-year-old man presents with a 4-month history of declining physical performance at work, accompanied by dysarthria and clumsiness. During the examination, he appears anemic and has hepatomegaly and Kayser-Fleischer rings in his cornea. He has a detectable liver edge. He denies excessive alcohol consumption and has no history of foreign travel, intravenous drug use, or unprotected sexual intercourse. His weekly alcohol intake is 0-2 units. He reports that his father passed away from a psychiatric illness in his mid-forties. What is the most probable diagnosis?

      Your Answer: Herpes encephalitis

      Correct Answer: Wilson’s disease

      Explanation:

      Differential Diagnosis for a Patient with Liver Failure and Neurological Symptoms

      Wilson’s Disease, Alcohol Abuse, Hepatitis C Infection, Herpes Encephalitis, and Motor Neurone Disease are all potential diagnoses for a patient presenting with liver failure and neurological symptoms. Wilson’s Disease is a genetic disorder that can present in childhood or early adulthood with hepatic or neurological/psychiatric manifestations. Alcohol abuse can cause acute liver failure and hepatitis, but Kayser-Fleischer rings are not associated with it. Hepatitis C infection is spread through blood-to-blood contact and is unlikely in this patient without risk factors. Herpes encephalitis is a viral encephalitis that presents acutely with confusion and altered consciousness, but the patient had a subacute presentation. Motor neurone disease can cause muscle atrophy and weight loss, but does not explain the liver failure. A thorough evaluation is necessary to determine the correct diagnosis.

    • This question is part of the following fields:

      • Neurology
      65.5
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  • Question 25 - A 72-year-old woman with a history of rheumatoid arthritis, hypertension and depression has...

    Incorrect

    • A 72-year-old woman with a history of rheumatoid arthritis, hypertension and depression has been experiencing severe pins and needles in her hands upon waking in the morning. The patient has worked as a stenographer for the last 25 years, and this sensation has been increasing in intensity over the past 7 years.
      What would be the anticipated findings for this patient based on her medical history and symptoms?

      Your Answer: Normal sensation over the radial aspect of the ring finger

      Correct Answer: Flattening of the thenar eminence

      Explanation:

      Understanding the Symptoms of Median Nerve Compression in Carpal Tunnel Syndrome

      Carpal tunnel syndrome is a condition that occurs when the median nerve is compressed within the carpal tunnel of the wrist. This can lead to a variety of symptoms, including numbness, weakness, and pain in the affected hand and fingers. Here are some common symptoms of median nerve compression in carpal tunnel syndrome and what they mean:

      Flattening of the thenar eminence: The thenar eminence is the fleshy area at the base of the thumb. When the median nerve is compressed, the muscles in this area may undergo wasting, leading to a flattened appearance.

      Numbness over the medial aspect of the ring finger: The median nerve supplies sensation to the lateral three and a half digits of the hand, including the ring finger. Numbness in this area may be a sign of median nerve compression.

      Inability to abduct the thumb: The abductor pollicis brevis muscle, which is innervated by the median nerve, is responsible for abducting the thumb. When the median nerve is compressed, this movement may be weakened.

      Numbness over the proximal palm: The median nerve gives off a palmar cutaneous branch before entering the carpal tunnel. This branch supplies sensation to the proximal palm and is therefore unaffected by median nerve compression.

      Normal sensation over the radial aspect of the ring finger: Despite supplying sensation to the lateral three and a half digits of the hand, the median nerve does not supply sensation to the dorsal aspect of the interdigital web between the thumb and index finger or the radial aspect of the ring finger. Therefore, sensation in this area would not be affected by median nerve compression.

      Understanding these symptoms can help individuals recognize the signs of carpal tunnel syndrome and seek appropriate treatment. Treatment options may include medication, wrist splints, and surgery to release the compressed nerve.

    • This question is part of the following fields:

      • Neurology
      20.3
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  • Question 26 - A 38-year-old computer programmer had been experiencing increasing right-hand pain during the last...

    Correct

    • A 38-year-old computer programmer had been experiencing increasing right-hand pain during the last 3 months, accompanied by loss of strength in his thumb. He was referred to a neurologist who ordered radiographic studies.
      Which condition does this man most likely have?

      Your Answer: Carpal tunnel syndrome

      Explanation:

      Common Hand and Arm Conditions: Symptoms and Treatments

      Carpal Tunnel Syndrome: This condition is caused by repetitive stress on the tendons in the wrist, leading to inflammation in the carpal tunnel and compression of the median nerve. Symptoms include atrophy of the muscles in the thenar eminence, particularly the flexor pollicis brevis, resulting in weakened thumb flexion. Treatment options include anti-inflammatory drugs and wrist splints, with surgery as a last resort.

      Dupuytren’s Contracture: This condition causes fixed flexion of the hand due to palmar fibromatosis, typically affecting the ring and little fingers. The index finger and thumb are usually not involved.

      Erb’s Palsy: This condition is characterized by paralysis of the arm due to damage to the brachial plexus, often caused by shoulder dystocia during difficult labor.

      Pronator Syndrome: This condition is caused by compression of the median nerve and results in pain and weakness in the hand, as well as loss of sensation in the thumb and first three fingers.

      Wrist Drop: Also known as radial nerve palsy, this condition causes an inability to extend the wrist and can be caused by stab wounds in the chest or fractures of the humerus. Treatment options depend on the underlying cause.

    • This question is part of the following fields:

      • Neurology
      7.3
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  • Question 27 - A 28-year-old motorcyclist is brought to the Emergency Department (ED) 45 minutes after...

    Incorrect

    • A 28-year-old motorcyclist is brought to the Emergency Department (ED) 45 minutes after a collision with a heavy-goods vehicle. Immediately after the collision she was unconscious for three minutes. Since regaining consciousness, she appears dazed and complains of a headache, nausea and ringing in her ears, and she is aversive to light and sound. Prior to examination she had an episode of vomiting.
      An ABCDE assessment is performed and the results are below:
      Airway Patent, able to speak
      Breathing Respiratory rate (RR) 18 per min, SaO2 97% on room air, normal and symmetrical chest expansion, normal percussion note bilaterally, normal vesicular breath sounds throughout
      Circulation Heart rate (HR) 97/min, blood pressure (BP) 139/87 mmHg, capillary refill time (CRT) <2 s, ECG with sinus tachycardia, normal heart sounds without added sounds or murmurs
      Disability AVPU, pupils equal and reactive to light, Glasgow Coma Scale (GCS) = 13 (E4, V4, M5), no signs suggestive of basal skull fracture
      Exposure Temperature 36.8 °C, multiple bruises but no sites of external bleeding, abdomen is soft and non-tender
      Which of the following would be appropriate in the further management of this patient?

      Your Answer: Immediate referral to neurosurgery

      Correct Answer: Computed tomography (CT) scan within eight hours

      Explanation:

      Management of Head Injury: Guidelines for CT Scan, Intubation, Neurosurgery Referral, Discharge, and Fluid Resuscitation

      Head injuries require prompt and appropriate management to prevent further complications. Evidence-based guidelines recommend performing a CT head scan within eight hours for adults who have lost consciousness temporarily or displayed amnesia since the injury, especially those with risk factors such as age >65 years, bleeding or clotting disorders, dangerous mechanism of injury, or more than 30 minutes of retrograde amnesia. If the patient has a GCS of <9, intubation and ventilation are necessary. Immediate referral to neurosurgery is not required unless there is further deterioration or a large bleed is identified on CT scan. Patients with reduced GCS cannot be discharged from the ED and require close monitoring. Fluid resuscitation with crystalloid, such as normal saline and/or blood, is crucial to avoid hypotension and hypovolaemia, while albumin should be avoided due to its association with higher mortality rates.

    • This question is part of the following fields:

      • Neurology
      428.8
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  • Question 28 - A 58-year-old man visits his GP complaining of constant fatigue and frontal hair...

    Correct

    • A 58-year-old man visits his GP complaining of constant fatigue and frontal hair loss. He has a medical history of high blood pressure and asthma and takes salbutamol, amlodipine, and simvastatin. He appears to be in good health, and his neurological exam is unremarkable. The results of his auto-antibody screen are negative, but his creatine kinase (CK) level is 1,000 U/l, which is higher than the normal range of 22-198 U/l. What is the most likely cause of this man's symptoms?

      Your Answer: Statin therapy

      Explanation:

      Understanding the Differential Diagnosis of Elevated CK Levels

      Elevated creatine kinase (CK) levels can indicate a variety of underlying conditions. When considering an elevated CK, it is important to take a detailed medication history as statin therapy, which is a common medication, can cause CK levels to rise in up to 5% of patients. Other common causes of mildly elevated CK include hypothyroidism, steroid use, and alcohol excess.

      Polymyositis is a potential differential diagnosis for a patient with elevated CK and fatigue, but it typically presents with objective proximal muscle weakness. The CK levels are often considerably higher than in the scenario described. Dermatomyositis, which features dermatological features alongside myositis, may present with papules on the hands, periorbital edema, flagellate erythema, or nailfold hemorrhages, none of which are present in this history.

      Extensive exercise can cause elevated CK levels, but it does not usually raise levels to the extent seen in this scenario. Rhabdomyolysis, which is a common cause of elevated CK, often occurs in elderly patients who have experienced a fall and long lie. However, there is no such history in this case, and CK levels in these patients are usually significantly higher.

      In summary, understanding the differential diagnosis of elevated CK levels requires a thorough evaluation of the patient’s medical history, medication use, and presenting symptoms.

    • This question is part of the following fields:

      • Neurology
      32
      Seconds
  • Question 29 - A 36-year-old man came to the Emergency Department complaining of a severe headache,...

    Incorrect

    • A 36-year-old man came to the Emergency Department complaining of a severe headache, neck stiffness, and photophobia. He had not experienced any recent foreign travel or trauma. Upon examination, he had a fever but no rash or focal neurology. The medical team suspected bacterial meningitis and began treatment. They also requested a lumbar puncture. What is the appropriate spinal level and dural space for the needle to be advanced to during a lumbar puncture?

      Your Answer: Between L2 and L3, advanced to the epidural space

      Correct Answer: Between L3 and L4, advanced to the subarachnoid space

      Explanation:

      Proper Placement for Lumbar Puncture

      The ideal location for a lumbar puncture is between L3 and L4, as this avoids the risk of piercing the spinal cord. To locate this area, a line is drawn across the superior aspect of the posterior iliac crests. The purpose of a lumbar puncture is to obtain a sample of cerebrospinal fluid from the subarachnoid space between the pia mater and the arachnoid mater. However, there are contraindications to this procedure, such as signs of raised intracranial pressure, which can lead to coning and respiratory arrest.

      It is important to note that advancing the needle too high, such as between L1 and L2, can pose a risk to the spinal cord. Additionally, the epidural space is too superficial to obtain a sample of cerebrospinal fluid. Therefore, proper placement between L3 and L4, advanced to the subarachnoid space, is crucial for a safe and successful lumbar puncture.

    • This question is part of the following fields:

      • Neurology
      34.1
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  • Question 30 - What brain structure is likely affected in a 72-year-old man who suddenly experiences...

    Incorrect

    • What brain structure is likely affected in a 72-year-old man who suddenly experiences paralysis on the left side of his body and oculomotor nerve dysfunction on the right side?

      Your Answer:

      Correct Answer: Midbrain

      Explanation:

      Weber’s Syndrome: A Midbrain Infarction

      Weber’s syndrome is a condition that occurs when there is an infarction in the midbrain. This can result in contralateral hemiplegia, which is paralysis on one side of the body, and ipsilateral oculomotor nerve palsy, which affects the eye muscles on the same side as the infarction. Patients with Weber’s syndrome often experience an abnormal level of consciousness and asymmetric hemiparesis or quadriparesis, which is weakness or paralysis in one or more limbs.

      In more than 70% of cases, patients also exhibit ipsilateral third nerve palsies with pupillary abnormalities and oculomotor signs. These symptoms can include drooping eyelids, double vision, and difficulty moving the eye in certain directions. Weber’s syndrome can be a serious condition that requires prompt medical attention. Treatment may involve medications to manage symptoms and physical therapy to help patients regain strength and mobility.

    • This question is part of the following fields:

      • Neurology
      0
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