-
Question 1
Incorrect
-
A 70-year-old man presents with symptoms including poor sleep. He reports an itching and crawling sensation affecting his legs with an overwhelming urge to move them. His wife reports that he tosses and turns all night, often pacing the room, and constantly rubs his legs. Things only improve with the break of dawn. He seems tired all day as a consequence of the disturbed sleep at night. The only past medical history of note is diverticular disease, from which he has been troubled by periodic iron deficiency anaemia. Neurological examination is unremarkable.
Bloods:
Investigation Result Normal value
Haemoglobin 101 g/l (microcytic) 135–175 g/l
White cell count (WCC) 5.1 × 109/l 4–11 × 109/l
Platelets 285 × 109/l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.1 mmol/l 3.5–5.0 mmol/l
Creatinine 124 μmol/l 50–120 µmol/l
Fasting glucose 5.8 mmol/l < 7 mmol/l
Which of the following diagnoses fits best with this clinical picture?Your Answer: Alcohol related neuropathy
Correct Answer: Secondary restless legs syndrome
Explanation:Differential Diagnosis for Restless Legs Syndrome
Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, often accompanied by unpleasant sensations. Here, we discuss the differential diagnosis for RLS in a patient with iron deficiency anaemia.
Secondary Restless Legs Syndrome:
In this case, the patient’s RLS is secondary to iron deficiency anaemia. Iron deficiency can cause RLS, and correcting the anaemia with iron supplementation may improve symptoms. Other causes of secondary RLS include peripheral neuropathy.Primary Restless Legs Syndrome:
Primary RLS is a central nervous system disorder without known underlying cause. However, since this patient has a known precipitant for his RLS, it is more likely to be secondary.Alcohol Related Neuropathy:
Alcohol-related neuropathy typically causes pain and motor loss, which is not seen in this patient.Nocturnal Cramps:
Nocturnal cramps are unlikely to cause problems for the whole night and are typically short-lived.Diabetic Neuropathy:
Diabetic neuropathy can cause burning or stinging sensations, but this patient’s fasting glucose level makes a diagnosis of diabetic neuropathy unlikely.In conclusion, RLS can have various causes, and a thorough evaluation is necessary to determine the underlying etiology. Treatment options include medications such as sedatives, anti-epileptic agents, and dopaminergic agents, as well as addressing any underlying conditions.
-
This question is part of the following fields:
- Neurology
-
-
Question 2
Incorrect
-
An epileptic teenager is seeking advice regarding their ability to drive following a seizure six months ago. On further enquiry, you discover that the seizure was in response to a medication change, which also took place six months ago and since being put back on their original medication, they have been seizure-free.
What advice is appropriate for this patient?Your Answer: She will have to wait another six months before she will be eligible to drive, allowing for 12 months following the seizure
Correct Answer: She can apply to the DVLA to reinstate her licence now
Explanation:Clarifying Misconceptions about Driving Eligibility for Patients with Epilepsy
There are several misconceptions about driving eligibility for patients with epilepsy. One common misconception is that a patient must wait another six months before being eligible to drive after a medication-induced seizure. However, according to DVLA guidance, if the patient has been seizure-free for six months on their working medication, they can apply to reinstate their licence.
Another misconception is that the patient must trial the new medication again to determine if they can drive. This is not true, as reverting back to the previous medication that did not work would not be helpful.
Additionally, some believe that the patient must wait another 12 months due to the medication change resulting in the seizure. However, the time a patient must be seizure-free is not increased because the seizure was medication-induced.
It is important to note that if a patient with epilepsy has been seizure-free for a certain period of time, depending on certain circumstances, they will be eligible to drive again in most cases. It is crucial for patients and healthcare professionals to have accurate information about driving eligibility for patients with epilepsy.
-
This question is part of the following fields:
- Neurology
-
-
Question 3
Correct
-
A 35-year-old female patient, who smokes and is taking the combined oral contraceptive pill, reports experiencing pain and swelling in her right calf for the past two days. She also presents with sudden onset weakness on her right side. Upon examination, she displays a dense hemiplegia, with upper motor neuron signs and weakness in her right hand. Additionally, evidence of a deep vein thrombosis in her right calf is observed. What is the probable diagnosis?
Your Answer: Paradoxical embolism
Explanation:Possible Embolic Cerebrovascular Accident in a Patient with History of DVT and Contraceptive Pill Use
This patient presents with symptoms suggestive of deep vein thrombosis (DVT), including calf pain and swelling, and has a history of using the combined oral contraceptive pill, which increases the risk of DVT. However, the sudden onset of right-sided hemiplegia indicates the possibility of an embolic cerebrovascular accident (CVA) caused by an embolus passing through the heart and crossing over to the systemic side of circulation via an atrial septal defect (ASD) or ventricular septal defect (VSD).
It is important to note that pulmonary embolism would not occur in this case without an ASD. While an aneurysm or hemorrhagic stroke are possible, they are less likely given the patient’s history of DVT. A tumor would also have a more chronic symptomatology, further supporting the possibility of an embolic CVA in this patient. Further diagnostic testing and treatment are necessary to confirm and address this potential complication.
-
This question is part of the following fields:
- Neurology
-
-
Question 4
Incorrect
-
A 9-year-old boy comes to his general practitioner complaining of severe pain in his right elbow area. He reports falling off his bike and landing on his outstretched arm.
During the examination of the affected limb, the radial pulse appears normal. The patient experiences weakness in finger flexion at the proximal interphalangeal joints in all digits, with the index and middle fingers showing particular weakness. The patient has no feeling in the palmar aspect of the thumb, index finger, and middle finger. Finger extension and abduction remain unaffected.
Which of these findings is most likely to be linked to this injury?Your Answer: Loss of function of the hypothenar muscles
Correct Answer: Persistent extension of the index and middle fingers when the boy attempts to make a fist
Explanation:Understanding Nerve Injuries in the Hand: Symptoms and Causes
When a child falls on their outstretched hand, it can result in a supracondylar fracture of the humerus. This type of injury can damage the brachial artery and median nerve, leading to symptoms such as persistent extension of the index and middle fingers when attempting to make a fist. Loss of sensation over the palmar aspect of the lateral three digits and weakness of finger flexion at the proximal interphalangeal joints are also common with median nerve injury. Additionally, the inability to flex the metacarpophalangeal joints of the index and middle fingers (known as the ‘hand of benediction’) is caused by loss of innervation of the first and second lumbrical muscles. Other symptoms of nerve injuries in the hand include loss of thumb adduction, loss of sensation over the medial border of the hand, loss of flexion at the distal interphalangeal joint of the little finger, and loss of function of the hypothenar muscles. Understanding these symptoms and their causes can help with early diagnosis and treatment of nerve injuries in the hand.
-
This question is part of the following fields:
- Neurology
-
-
Question 5
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: Left vertebral 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
-
-
Question 6
Incorrect
-
An action potential reaches the presynaptic membrane of a central neurone's axon. What is the primary effect it produces?
Your Answer: Hyperpolarisation of the presynaptic membrane
Correct Answer: Opening of voltage-gated calcium channels
Explanation:The Role of Voltage-Gated Calcium Channels in Neurotransmitter Release
When an action potential occurs in a presynaptic neuron, it triggers the opening of voltage-gated calcium channels. This allows calcium ions to enter the neuron, initiating a series of events that lead to the release of neurotransmitters into the synaptic cleft. These neurotransmitters can then bind to receptors on the postsynaptic neuron, transmitting the signal across the synapse.
It is important to note that other types of ion channels, such as voltage-gated chloride, potassium, and sodium channels, are not typically found in the synaptic membrane of central neurons. Therefore, the opening of voltage-gated calcium channels is the key event that triggers neurotransmitter release.
the role of voltage-gated calcium channels in neurotransmitter release is crucial for how neurons communicate with each other. By studying these processes, researchers can gain insights into the mechanisms underlying normal brain function as well as neurological disorders.
-
This question is part of the following fields:
- Neurology
-
-
Question 7
Incorrect
-
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: Serum glucose
Correct 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
-
-
Question 8
Incorrect
-
A 2-day-old infant is diagnosed with an intraventricular haemorrhage. What is commonly linked with this diagnosis?
Your Answer: Hyaline membrane disease
Correct Answer: Prematurity
Explanation:Prematurity and Intraventricular Haemorrhages
Prematurity is linked to the occurrence of intraventricular haemorrhages, which are believed to be caused by the fragility of blood vessels. However, it is important to note that intraventricular haemorrhage is not typically a symptom of haemophilia.
Prematurity refers to a baby being born before the 37th week of pregnancy. Babies born prematurely are at a higher risk of developing intraventricular haemorrhages, which occur when there is bleeding in the brain’s ventricles. This is because the blood vessels in premature babies’ brains are not fully developed and are therefore more fragile. Intraventricular haemorrhages can lead to serious complications, such as brain damage and developmental delays.
On the other hand, haemophilia is a genetic disorder that affects the blood’s ability to clot. While haemophilia can cause bleeding in various parts of the body, it is not typically associated with intraventricular haemorrhages. It is important to differentiate between the two conditions to ensure proper diagnosis and treatment.
-
This question is part of the following fields:
- Neurology
-
-
Question 9
Correct
-
A 40-year-old man presents with wrist drop in his right hand. Upon examination, a small region of sensory loss is noted on the back of his hand. Which nerve is most likely affected?
Your Answer: Radial nerve
Explanation:The radial nerve supplies muscles in the forearm and sensation to the dorsum of the thumb and fingers. Damage results in wrist drop and impaired sensation. The long thoracic nerve supplies serratus anterior and damage causes winging of the scapula. Median nerve palsy results in weakness in thumb and finger movement and sensory loss. T1 nerve root lesion results in Klumpke’s palsy. Ulnar nerve compression results in numbness and weakness in the hand, and can progress to a claw hand.
-
This question is part of the following fields:
- Neurology
-
-
Question 10
Incorrect
-
A 6-year-old boy who has recently been diagnosed with Duchenne muscular dystrophy (DMD) is seen in a specialist clinic with his mother. She asks the doctor if there is a treatment to slow the progression of the disease.
Which treatment slows the progression of muscle weakness in DMD?Your Answer: Gene therapy
Correct Answer: Steroids
Explanation:Treatment Options for Duchenne Muscular Dystrophy
Duchenne muscular dystrophy (DMD) is a genetic condition that causes progressive muscle weakness and wasting due to the lack of the dystrophin protein. While there is currently no cure for DMD, there are several treatment options available to manage symptoms and slow the progression of the disease.
Steroids are the mainstay of pharmacological treatment for DMD. They can slow the decline in muscle strength and motor function if started before substantial physical decline and if the side-effects of long-term steroid use are effectively managed.
Ataluren is a medication that restores the synthesis of dystrophin in patients with nonsense mutations. It is used in patients aged less than five years with nonsense mutations who are able to walk and slows the decline in physical function.
Immunoglobulin therapy is sometimes used for autoimmune myositis, but has no role in the treatment of DMD.
Gene therapy seeks to manipulate the expression of a gene for therapeutic use in genetic conditions. Although there are currently clinical trials underway, gene therapy is not currently available for use in DMD.
Methotrexate and other disease-modifying anti-rheumatic drugs may be used in the treatment of myositis, but have no role in the treatment of DMD.
Biological therapies such as rituximab are often used in the treatment of rheumatoid arthritis and psoriatic arthritis, as well as myositis, but have no role in the treatment of DMD.
Managing Duchenne Muscular Dystrophy: Treatment Options
-
This question is part of the following fields:
- Neurology
-
-
Question 11
Correct
-
A 26-year-old female presents to the hospital with a sudden and severe occipital headache while decorating at home. She experienced vomiting and a brief loss of consciousness. Upon examination, her Glasgow coma scale (GCS) score is 15, and she has a normal physical exam except for an abrasion on her right temple. She is afebrile, has a blood pressure of 146/84 mmHg, and a pulse rate of 70 beats/minute. What investigation would be the most beneficial?
Your Answer: Computed tomography (CT) brain scan
Explanation:Diagnosis of Subarachnoid Haemorrhage
The sudden onset of a severe headache in a young woman, accompanied by vomiting and loss of consciousness, is indicative of subarachnoid haemorrhage. The most appropriate diagnostic test is a CT scan of the brain to detect any subarachnoid blood. However, if the CT scan is normal, a lumbar puncture should be performed as it can detect approximately 10% of cases of subarachnoid haemorrhage that may have been missed by the CT scan. It is important to diagnose subarachnoid haemorrhage promptly as it can lead to serious complications such as brain damage or death. Therefore, healthcare professionals should be vigilant in identifying the symptoms and conducting the appropriate diagnostic tests to ensure timely treatment.
-
This question is part of the following fields:
- Neurology
-
-
Question 12
Correct
-
A 50-year-old patient with diabetes presents to the Emergency department with complaints of dizziness and vomiting. Upon examination, the patient is alert and oriented, with an irregularly irregular pulse of 80 and a blood pressure of 160/90 mmHg. Nystagmus is observed on left lateral gaze, and the patient's speech is slurred. Intention tremor and past pointing are noted during examination of the limbs, and the patient is ataxic when mobilized. What is the probable diagnosis?
Your Answer: Cerebellar CVA
Explanation:Differential Diagnosis for a Patient with Vertigo and Cerebellar Signs
This patient presents with a history of vertigo and clinical signs of nystagmus, as well as slurred speech, intention tremor, past pointing, and ataxia. These symptoms suggest an injury to the cerebellum. The patient also has risk factors for cerebrovascular disease, including atrial fibrillation and hypertension.
Labyrinthitis, which is associated with nystagmus, would not produce cerebellar signs. Wernicke’s encephalopathy, on the other hand, would present with confusion, ophthalmoplegia, and ataxia. Subacute combined degeneration of the cord is associated with posterior column signs, loss of vibration sensation, and a positive Romberg’s test. Brainstem signs would be expected with a brainstem CVA and impaired conscious level.
In summary, this patient’s symptoms suggest an injury to the cerebellum, possibly due to cerebrovascular disease. Other potential diagnoses, such as labyrinthitis, Wernicke’s encephalopathy, subacute combined degeneration of the cord, and brainstem CVA, can be ruled out based on the absence of certain symptoms.
-
This question is part of the following fields:
- Neurology
-
-
Question 13
Incorrect
-
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)?Your Answer: 8
Correct Answer: 9
Explanation:Understanding the Glasgow Coma Scale (GCS)
The Glasgow Coma Scale (GCS) is a widely used tool for assessing a patient’s level of consciousness, particularly in cases of head injury. It consists of three components: eye response, verbal response, and motor response. Each component is scored on a scale from 1 to a maximum value (4 for eye response, 5 for verbal response, and 6 for motor response), with a total possible score of 15.
To remember the components and their values, use the acronym EVM (eyes, verbal, motor) and the fact that eyes has 4 letters, V represents 5 in Roman numerals, and M6 is a famous motorway in the UK.
A patient’s GCS score can help determine the severity of their condition and guide treatment decisions. A score of less than 8 indicates the need for intubation to maintain the patient’s airway. It’s important to note that the minimum possible score is 3, not zero.
When assessing a patient’s GCS, evaluate their eye response (spontaneous, to verbal command, to painful stimulus, or none), verbal response (oriented speech, confused speech, inappropriate words, incomprehensible sounds, or none), and motor response (obeys commands, localizes to pain, withdraws from pain, flexes in response to pain, extends in response to pain, or none). By understanding the GCS and its components, healthcare providers can better assess and manage patients with altered levels of consciousness.
-
This question is part of the following fields:
- Neurology
-
-
Question 14
Correct
-
A 55-year-old woman presented to her GP with a four month history of progressive distal sensory loss and weakness of both legs and arms. The weakness and numbness had extended to the elbows and knees.
On examination, cranial nerves and fundoscopy were normal. Examination of the upper limb revealed bilaterally reduced tone and 3/5 power.
Lower limb examination revealed some mild weakness of hip flexion and extension with marked weakness of dorsiflexion and plantarflexion. Both knee and ankle jerks were absent and both plantar responses were mute. There was absent sensation to all modalities affecting both feet extending to the knees.
A lumbar puncture was performed and yielded the following data:
Opening pressure 14 cm H2O (5-18)
CSF protein 0.75 g/L (0.15-0.45)
CSF white cell count 10 cells per ml (<5 cells)
CSF white cell differential 90% lymphocytes -
CSF red cell count 2 cells per ml (<5 cells)
Nerve conduction studies showed multifocal motor and sensory conduction block with prolonged distal latencies.
What is the likely diagnosis in this patient?Your Answer: Chronic inflammatory demyelinating neuropathy (CIDP)
Explanation:The patient’s history is consistent with a subacute sensory and motor peripheral neuropathy, which could be caused by inflammatory neuropathies such as CIDP or paraproteinaemic neuropathies. CIDP is characterized by progressive weakness and impaired sensory function in the limbs, and treatment includes corticosteroids, plasmapheresis, and physiotherapy. Guillain-Barré syndrome is an acute post-infectious neuropathy that is closely linked to CIDP. Cervical spondylosis would cause upper motor neuron signs, while HMSN is a chronic neuropathy with a family history. Multifocal motor neuropathy is a treatable neuropathy affecting motor conduction only.
-
This question is part of the following fields:
- Neurology
-
-
Question 15
Incorrect
-
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 examination is unremarkable. The auto-antibody screen is negative, and his creatine kinase (CK) level is 1,000 U/l (normal range: 22-198 U/l). What is the most likely cause of this man's symptoms?
Your Answer: Rhabdomyolysis
Correct 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
-
-
Question 16
Correct
-
A 28-year-old woman presents to her primary care physician with concerning symptoms that have been occurring on and off for the past few months. She reports experiencing episodes of weakness accompanied by rapid, involuntary movements of her arms. Additionally, she has been experiencing persistent tingling sensations, occasional double vision, electric shocks down her arms and trunk when she flexes her neck, and constipation. Based on these symptoms, what would be the most appropriate initial test to diagnose her condition?
Your Answer: MRI
Explanation:Diagnosing Multiple Sclerosis: The Importance of MRI
Multiple sclerosis (MS) is a debilitating disease that affects many individuals, particularly women. Symptoms can range from spastic weakness to loss of vision, making it difficult to diagnose. However, the first line investigation for somebody with MS is an MRI of the brain and spinal cord. This is because MRI is much more sensitive for picking up inflammation and demyelination than a CT scan, and it does not involve irradiation. Additionally, lumbar puncture can be used to detect IgG oligoclonal bands, which are not present in the serum. While other tests such as antibody testing and slit-lamp examination of the eyes may be useful, they are not first line investigations. It is important to diagnose MS early to prevent further damage to myelin sheaths and improve quality of life.
-
This question is part of the following fields:
- Neurology
-
-
Question 17
Incorrect
-
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: Emery–Dreifuss muscular dystrophy
Correct 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
-
-
Question 18
Incorrect
-
A middle-aged woman reports to her general practitioner that she has noticed recent changes in her strength and endurance. Although she was active in her youth, she now reports weakness in her arms following formerly simple tasks. She no longer goes on long walks because of difficulty catching her breath on exertion. Her eyelids are droopy and she experiences difficulty holding her head upright.
What is the most likely disease?Your Answer: Mitochondrial myopathy
Correct Answer: Myasthenia gravis
Explanation:Muscle Disorders: Types and Characteristics
Myasthenia gravis is an autoimmune disorder that affects the acetylcholine receptor at the neuromuscular junction, leading to muscle weakness. It is more common in females and typically appears in early adulthood. Acetylcholinesterase inhibitors can provide partial relief.
Nemaline myopathy is a congenital myopathy that presents as hypotonia in early childhood. It has both autosomal recessive and dominant forms.
Mitochondrial myopathy is a complex disease caused by defects in oxidative phosphorylation in mitochondria. It can result from mutations in nuclear or mitochondrial DNA and typically manifests earlier in life.
Poliomyelitis is a viral disease that causes muscle weakness, but it is now rare due to widespread vaccination.
Duchenne muscular dystrophy is an X-linked disease that only affects males and typically appears by age 5.
-
This question is part of the following fields:
- Neurology
-
-
Question 19
Incorrect
-
A 68-year-old man presents to the general practitioner (GP) with visual complaints in the right eye. He intermittently loses vision in the right eye, which he describes as a curtain vertically across his visual field. Each episode lasts about two or three minutes. He denies eye pain, eye discharge or headaches.
His past medical history is significant for poorly controlled type 2 diabetes mellitus, hypertension and hypercholesterolaemia.
On examination, his pupils are of normal size and reactive to light. There is no scalp tenderness. Blood test results are pending, and his electrocardiogram (ECG) shows normal sinus rhythm, without ischaemic changes.
A provisional diagnosis of amaurosis fugax (AG) is being considered.
Given this diagnosis, which of the following is the most appropriate treatment at this time?Your Answer: Prednisolone
Correct Answer: Aspirin
Explanation:Treatment Options for Transient Vision Loss: Aspirin, Prednisolone, Warfarin, High-Flow Oxygen, and Propranolol
Transient vision loss can be a symptom of various conditions, including giant-cell arthritis (temporal arthritis) and transient retinal ischaemia. The appropriate treatment depends on the underlying cause.
For transient retinal ischaemia, which is typically caused by atherosclerosis of the ipsilateral carotid artery, antiplatelet therapy with aspirin is recommended. Patients should also be evaluated for cardiovascular risk factors and considered for ultrasound of the carotid arteries.
Prednisolone is used to treat giant-cell arthritis, which is characterised by sudden mononuclear loss of vision, jaw claudication, and scalp tenderness. However, if the patient does not have scalp tenderness or jaw claudication, oral steroids would not be indicated.
Warfarin may be considered in patients with underlying atrial fibrillation and a high risk of embolic stroke. However, it should typically be bridged with a heparin derivative to avoid pro-thrombotic effects in the first 48-72 hours of use.
High-flow oxygen is used to treat conditions like cluster headaches, which present with autonomic manifestations. If the patient does not have any autonomic features, high-flow oxygen would not be indicated.
Propranolol can be used in the prophylactic management of migraines, which can present with transient visual loss. However, given the patient’s atherosclerotic risk factors and description of visual loss, transient retinal ischaemia is a more likely diagnosis.
In summary, the appropriate treatment for transient vision loss depends on the underlying cause and should be tailored to the individual patient’s needs.
-
This question is part of the following fields:
- Neurology
-
-
Question 20
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: Vascular dementia
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
-
-
Question 21
Correct
-
A 60-year-old woman visits her GP with a complaint of hoarseness in her voice for a few weeks. She underwent a thyroidectomy a decade ago. During the examination, the doctor observed decreased breath sounds in the left upper lobe. The patient has a smoking history of 75 pack years and quit five years ago. A chest X-ray revealed an opacity in the left upper lobe. Which cranial nerve is likely to be impacted?
Your Answer: Vagus
Explanation:Cranial Nerves and their Functions: Analysis of a Patient’s Symptoms
This patient is experiencing a hoarse voice and change in pitch, which is likely due to a compression of the vagus nerve caused by an apical lung tumor. The vagus nerve is the 10th cranial nerve and provides innervation to the laryngeal muscles. The other cranial nerves, such as the trigeminal, facial, glossopharyngeal, and hypoglossal, have different functions and would not be affected by a left upper lobe opacity. Understanding the functions of each cranial nerve can aid in diagnosing and treating patients with neurological symptoms.
-
This question is part of the following fields:
- Neurology
-
-
Question 22
Correct
-
A 40-year-old woman presents to your clinic with complaints of difficulty reading, which she has noticed over the past two weeks. She has never worn glasses and is not taking any medications.
Upon examination, her pupils are of normal size but react sluggishly to light. Both optic discs appear sharp, without signs of haemorrhages or exudates. However, her visual acuity is significantly impaired and remains so even when using a pinhole card. Additionally, she exhibits five-beat nystagmus and double vision when looking to the left.
What is the most likely diagnosis for this patient?Your Answer: Multiple sclerosis
Explanation:Possible Diagnosis of Multiple Sclerosis in a Young Woman
This young woman shows signs of retrobulbar neuritis, which is characterized by inflammation of the optic nerve behind the eye. Additionally, she exhibits some cerebellar features such as nystagmus, which is an involuntary eye movement. These symptoms suggest a possible diagnosis of Multiple sclerosis (MS), a chronic autoimmune disease that affects the central nervous system.
Further diagnostic tests can support this diagnosis. Visual evoked responses can measure the electrical activity in the brain in response to visual stimuli, which can be abnormal in MS. Magnetic resonance imaging (MRI) can reveal demyelinating plaques, or areas of damage to the protective covering of nerve fibers in the brain and spinal cord. Finally, oligoclonal bands can be detected in the cerebrospinal fluid (CSF) of MS patients, indicating an immune response in the central nervous system.
In summary, this young woman’s symptoms and diagnostic tests suggest a possible diagnosis of MS. Further evaluation and treatment by a healthcare professional are necessary to confirm this diagnosis and manage her symptoms.
-
This question is part of the following fields:
- Neurology
-
-
Question 23
Incorrect
-
A 78-year-old man visits his General Practitioner (GP) with his wife, complaining of feeling excessively tired during the day. He has been prescribed donepezil for Alzheimer's disease (AD), and he has observed some improvement in his cognitive abilities with this medication. However, his wife reports that he struggles to sleep at night and is becoming increasingly lethargic during the day.
What is the most suitable course of action for this patient?Your Answer: Memantine
Correct Answer: Trazodone
Explanation:Medications for Alzheimer’s Disease: Choosing the Right Treatment
Alzheimer’s Disease (AD) is a progressive neurodegenerative disorder that affects memory, thinking, and behavior. Patients with AD often experience sleeping difficulties due to changes in circadian rhythms and medication side-effects. Trazodone, an atypical antidepressant, is often used as adjunctive treatment in patients with AD to manage insomnia. Along with sleep hygiene measures, such as avoidance of naps, daytime activity, and frequent exercise, trazodone is likely to help this patient’s sleeping problems.
Risperidone, an atypical antipsychotic, is used to manage the psychotic manifestations of AD. However, the clinical scenario has not provided any evidence that the patient is suffering from psychosis. Rivastigmine, a cholinesterase inhibitor, is unlikely to benefit the patient who is already taking a similar medication.
Memantine, an N-methyl-D-aspartate (NMDA) receptor antagonist, can be used as adjunctive treatment or monotherapy in patients who do not tolerate cholinesterase inhibitors. However, this patient is experiencing sleeping difficulty and is more likely to benefit from a medication that specifically targets this clinical problem.
Tacrine, a centrally acting anticholinesterase inhibitor medication, was previously used for the management of AD. However, due to its potent side-effect profile of fatal hepatotoxicity, it is now rarely used. Additionally, tacrine is unlikely to help this patient’s insomnia.
Choosing the right medication for AD requires careful consideration of the patient’s symptoms and potential side-effects. Trazodone may be a suitable option for managing insomnia in patients with AD.
-
This question is part of the following fields:
- Neurology
-
-
Question 24
Incorrect
-
What impact would a voltage-gated calcium channel inhibitor have on action potentials in the central nervous system?
Your Answer: Inhibition of presynaptic potentials
Correct Answer: Decrease of postsynaptic potentials
Explanation:Effects of Inhibition of Voltage-Gated Channels in the Central Nervous System
In the central nervous system, voltage-gated calcium channels play a crucial role in the release of neurotransmitters. On the other hand, action potentials involve sodium and potassium voltage-gated channels. If these channels are inhibited, the amount of neurotransmitter released would decrease, leading to a subsequent decrease in the postsynaptic potentials, both graded and action. It is important to note that the decrease in postsynaptic potentials is the only correct option from the given choices.
It is incorrect to assume that the inhibition of voltage-gated channels would lead to a decrease in action potential amplitude. This is because the amplitude of an action potential is an all-or-none event, and it is the frequency of action potentials that determines the strength of a stimulus. Similarly, the decrease in action potential conduction speed is also incorrect as it depends on the myelination of the axon. Moreover, it is incorrect to assume that inhibiting voltage-gated channels would increase the speed and amplitude of action potentials.
Lastly, inhibiting presynaptic potentials is also incorrect as they depend on sodium/potassium voltage-gated ion channels. Therefore, it is essential to understand the effects of inhibiting voltage-gated channels in the central nervous system to avoid any misconceptions.
-
This question is part of the following fields:
- Neurology
-
-
Question 25
Correct
-
A 56-year-old woman visits her doctor with complaints of progressive weakness over the past few months. She reports difficulty getting up from a chair and climbing stairs, which worsens throughout the day and especially with prolonged walking. She has no significant medical history but is a smoker, consuming 15 cigarettes a day. During the review of her systems, she mentions a loss of appetite and weight loss, as well as a worsening cough that led to one episode of haemoptysis two weeks ago. On examination, there are no clear signs of ptosis, diplopia, or dysarthria. The doctor considers a list of differential diagnoses.
Which antibody is most likely to be involved?Your Answer: Antibodies to voltage-gated calcium channels
Explanation:Autoantibodies and their associated conditions
Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune condition affecting skeletal muscle and can be a paraneoplastic syndrome associated with small cell carcinoma of the lung. The causative autoantibody is against voltage-gated calcium channels. Clinical features include insidious and progressive onset of proximal muscular weakness, particularly in the legs, and autonomic involvement.
Mixed connective tissue disease (MCTD) is associated with anti-RNP antibodies. Common presenting features include general malaise and lethargy, arthritis, pulmonary involvement, sclerodactyly, Raynaud’s phenomenon, and myositis.
Myasthenia gravis is a long-term autoimmune disease affecting skeletal muscle associated with antibodies to acetylcholine receptors. It causes fatigable weakness, and oculopharyngeal and ocular muscles are usually prominently affected.
Granulomatosis with polyangiitis is a vasculitic condition associated with c-ANCA antibodies. It often presents with renal impairment, upper airway disease, and pulmonary haemorrhage and pneumonia-like infiltrates.
Thyrotropin receptor antibody is an indicator for Graves’ disease, which causes hyperthyroidism.
-
This question is part of the following fields:
- Neurology
-
-
Question 26
Incorrect
-
A 29-year-old man presents to the Emergency Department with his friend after collapsing during a soccer match. He fell to the ground suddenly, losing consciousness. Witnesses reported jerking movements of his limbs and incontinence before the episode self-terminated after a few minutes. He has a history of psoriasis and takes methotrexate once weekly. He is urgently referred to a Neurology Clinic for review. Physical examination is normal, and investigations reveal no abnormalities except for a slightly elevated TSH level. What is the most likely cause of his presentation?
Your Answer: Hypothyroidism
Correct Answer: Epilepsy
Explanation:Understanding the Differential Diagnosis of a First Tonic-Clonic Seizure
A first tonic-clonic seizure can be a challenging diagnosis to make, and further investigation is required to determine the underlying cause. While an EEG can confirm seizure activity in around 70% of cases, it is not a definitive test and a negative result does not rule out epilepsy. However, given the history of a tonic-clonic seizure, epilepsy is the most likely diagnosis.
Other potential causes, such as head injury, hypothyroidism, methotrexate toxicity, and psychogenic seizure, should also be considered. Head injury is a risk factor for epilepsy, but there is no history of head injury in this scenario. Hypothyroidism is not clinically or biochemically present in the patient. Methotrexate toxicity may precipitate seizures in those with previously controlled epilepsy, but it is not a significant risk factor for first fits. Psychogenic non-epileptic seizures are an important differential, but the presence of incontinence and the characteristics of the seizure make it less likely.
Overall, a thorough investigation is necessary to determine the underlying cause of a first tonic-clonic seizure.
-
This question is part of the following fields:
- Neurology
-
-
Question 27
Correct
-
An 80-year-old man is admitted to hospital after suddenly losing all sensation to his right leg and right arm. He has no loss of consciousness, no visual disturbances, no slurring of speech and no motor symptoms. A stroke is suspected.
Based on the findings, what type of stroke is most likely?Your Answer: Lacunar stroke
Explanation:Understanding Different Types of Strokes: A Guide to Symptoms and Diagnoses
When it comes to strokes, there are different types that can affect individuals in various ways. One type of stroke is a lacunar stroke, which typically presents with purely sensory symptoms. This occurs when small infarcts develop around the basal ganglia, internal capsule, thalamus, or pons. Lacunar strokes can present in five different ways, including pure motor, pure sensory, mixed sensorimotor, dysarthria, and ataxic hemiparesis.
Another type of stroke is Millard-Gubler syndrome, which is caused by a PICA or vertebral artery. This syndrome typically presents with paralysis of the abducens resulting in diplopia and loss of lateral movement of the eye, as well as paralysis of the facial muscles. However, it would not result in pure sensory symptoms.
Locked-in syndrome is another type of stroke, but it is characterized by widespread motor paralysis, which is not present in the case of the patient with purely sensory symptoms.
Partial anterior circulation stroke and total anterior circulation stroke are two other types of strokes that can occur. A partial anterior circulation stroke would have two out of three symptoms, including hemiparesis and/or sensory deficit, homonymous hemianopia, and higher cortical dysfunction. On the other hand, a total anterior circulation stroke would have all three of these symptoms present.
Understanding the different types of strokes and their associated symptoms can help healthcare professionals diagnose and treat patients more effectively.
-
This question is part of the following fields:
- Neurology
-
-
Question 28
Correct
-
A 21-year-old woman attends the antenatal clinic, six weeks pregnant with an unplanned pregnancy. She has a history of grand mal epilepsy for two years and is currently taking carbamazepine. She has not had any seizures for the past six months and wishes to continue with the pregnancy if it is safe for her and the baby. She is concerned about the effects of her anticonvulsant therapy on the fetus and seeks advice on how to proceed. What is the most suitable management plan for this patient?
Your Answer: Continue with carbamazepine
Explanation:Managing Epilepsy in Pregnancy
During pregnancy, it is important to manage epilepsy carefully to ensure the safety of both the mother and the fetus. Uncontrolled seizures pose a greater risk than any potential teratogenic effect of the therapy. However, total plasma concentrations of anticonvulsants tend to fall during pregnancy, so the dose may need to be increased. It is important to explain the potential teratogenic effects of carbamazepine, particularly neural tube defects, and provide the patient with folate supplements to reduce this risk. Screening with alpha fetoprotein (AFP) and second trimester ultrasound are also required. Vitamin K should be given to the mother prior to delivery. Switching therapies is not recommended as it could precipitate seizures in an otherwise stable patient. It is important to note that both phenytoin and valproate are also associated with teratogenic effects.
-
This question is part of the following fields:
- Neurology
-
-
Question 29
Incorrect
-
A 67-year-old male comes to the clinic with a complaint of sudden flailing of his left arm. During examination, it is observed that his left arm occasionally makes rapid, sudden, and uncontrollable thrusts. What is the diagnosis for this condition?
Your Answer: Chorea
Correct Answer: Hemiballismus
Explanation:Hemiballismus: A Sudden Thrusting Movement of the Right Arm
Hemiballismus is a medical condition characterized by a sudden, forceful movement of the right arm. This condition is caused by a lesion in the subthalamic nucleus on the opposite side of the brain. The lesion can be a result of a stroke or trauma.
The subthalamic nucleus is a small structure located deep within the brain that plays a crucial role in controlling movement. When it is damaged, it can cause involuntary movements, such as hemiballismus. This condition can be distressing for the patient and can interfere with their daily activities.
Treatment for hemiballismus typically involves addressing the underlying cause of the lesion, such as managing stroke risk factors or providing rehabilitation for trauma. Medications may also be prescribed to help control the involuntary movements. In severe cases, surgery may be necessary to remove the damaged tissue.
In conclusion, hemiballismus is a medical condition that causes sudden, forceful movements of the right arm due to a lesion in the subthalamic nucleus. It can be caused by stroke or trauma and can be treated with medication, rehabilitation, or surgery.
-
This question is part of the following fields:
- Neurology
-
-
Question 30
Incorrect
-
A 25-year-old university student exhibits involuntary head twitching and flicking of his hands. He also says that he suffers from embarrassing grunting which can affect him at almost any time. When he is in lectures at the university he manages to control it, but often when he comes home and relaxes the movements and noises get the better of him. His girlfriend who attends the consultation with him tells you that he seems very easily distracted and often is really very annoying, repeating things which she says to him and mimicking her. On further questioning, it transpires that this has actually been a problem since childhood. On examination his BP is 115/70 mmHg, pulse is 74 beats/min and regular. His heart sounds are normal, respiratory, abdominal and neurological examinations are entirely normal.
Investigations:
Investigation Result Normal value
Haemoglobin 129 g/l 135–175 g/l
White Cell Count (WCC) 8.0 × 109/l 4–11 × 109/l
Platelets 193 × 109 /l 150–400 × 109/l
Sodium (Na+) 139 mmol/l 135–145 mmol/l
Potassium (K+) 4.5 mmol/l 3.5–5.0 mmol/l
Creatinine 95 μmol/l 50–120 µmol/l
Alanine Aminotransferase (ALT) 23 IU/l 5–30 IU/l
Which one of the following is the most likely diagnosis?Your Answer: Wilson's disease
Correct Answer: Gilles de la Tourette syndrome
Explanation:Distinguishing Movement Disorders: Gilles de la Tourette Syndrome, Congenital Cerebellar Ataxia, Haemochromatosis, Huntington’s Disease, and Wilson’s Disease
Gilles de la Tourette syndrome is characterized by motor and vocal tics that are preceded by an unwanted premonitory urge. These tics may be suppressible, but with associated tension and mental exhaustion. The diagnosis is based on clinical presentation and history, with an association with attention-deficit hyperactivity disorder, obsessive-compulsive disorder, behavioural problems, and self-mutilation. The pathophysiology is unknown, but treatments include neuroleptics, atypical antipsychotics, and benzodiazepines.
Congenital cerebellar ataxia typically presents with a broad-based gait and dysmetria, which is not seen in this case. Haemochromatosis has a controversial link to movement disorders. Huntington’s disease primarily presents with chorea, irregular dancing-type movements that are not repetitive or rhythmic and lack the premonitory urge and suppressibility seen in Tourette’s. Wilson’s disease has central nervous system manifestations, particularly parkinsonism and tremor, which are not present in this case. It is important to distinguish between these movement disorders for proper diagnosis and treatment.
-
This question is part of the following fields:
- Neurology
-
-
Question 31
Incorrect
-
A 42-year-old woman comes to the Neurology Clinic with complaints of painful unilateral visual disturbance, ataxia, and sensory deficit. She is diagnosed with multiple sclerosis (MS) after undergoing magnetic resonance imaging (MRI) and is started on steroid treatment, followed by disease-modifying therapy. Her disease is stable after six months, and she can manage her daily activities without significant problems. She used to drive a car but has not done so since her diagnosis. She is now curious about her driving situation.
What are the most appropriate steps to take regarding her driving circumstances?Your Answer: She must inform the DVLA and cannot drive for six months since her most recent relapse
Correct Answer: She must inform the DVLA and may continue to drive
Explanation:Driving with Multiple Sclerosis: Informing the DVLA
Multiple Sclerosis (MS) is a chronic neurological disorder that may affect vehicle control due to impaired coordination and muscle strength. It is essential to inform the Driver and Vehicle Licensing Agency (DVLA) upon diagnosis. The official guidance states that patients with MS may continue to drive as long as safe vehicle control is maintained. However, it is necessary to update the DVLA if circumstances change. There is no arbitrary timeframe for inability to drive, and it is assessed individually based on the state of the patient’s chronic disease. It is not appropriate to base this on relapses as patients may relapse at different time periods and tend not to return to baseline function in relapsing-remitting MS. Failure to inform the DVLA can result in legal consequences. Therefore, it is crucial to inform the DVLA and follow their guidelines to ensure safe driving.
-
This question is part of the following fields:
- Neurology
-
-
Question 32
Incorrect
-
A 70-year-old man is admitted at the request of his family due to a 3-month history of increasing confusion and unsteady gait. They have also noted intermittent jerking movements of both upper limbs. He was previously healthy and till the onset of symptoms, had continued to work part-time as a carpenter. On examination, he is not orientated to time, person or place. Myoclonic jerks of both upper limbs are noted together with non-specific cerebellar signs. CT brain and blood work-up for common causes of dementia is normal.
Which of the following tests will help in diagnosis?Your Answer: Renal biopsy
Correct Answer: MRI of the brain
Explanation:Diagnostic Procedures for Suspected Sporadic Creutzfeldt-Jakob Disease
Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and fatal neurological disorder that presents with rapidly progressive dementia and other non-specific neurological symptoms. Here, we discuss the diagnostic procedures that are typically used when sCJD is suspected.
Clinical diagnosis of sCJD is based on a combination of typical history, MRI findings, positive CSF 14-3-3 protein, and characteristic EEG findings. Definitive diagnosis can only be made from biopsy, but this is often not desirable due to the difficulty in sterilizing equipment.
Renal biopsy is not indicated in cases of suspected sCJD, as the signs and symptoms described are not indicative of renal dysfunction. Echocardiography is also not necessary, as sCJD does not affect the heart.
Muscle biopsy may be indicated in suspected myopathic disorders, but is not useful in diagnosing sCJD. Similarly, bone marrow biopsy is not of diagnostic benefit in this case.
Overall, a combination of clinical history, imaging, and laboratory tests are used to diagnose sCJD, with biopsy reserved for cases where definitive diagnosis is necessary. It is important to note that there is currently no curative treatment for sCJD, and the disease is invariably fatal.
-
This question is part of the following fields:
- Neurology
-
-
Question 33
Correct
-
What distinguishes graded potentials from action potentials?
Your Answer: Graded potentials are localised, while action potentials conduct across the entire axon
Explanation:Graded Potentials vs. Action Potentials
Graded potentials are changes in the transmembrane potential that occur mainly in the dendrites and soma of a neuron. These changes do not cause significant depolarization to spread far from the area surrounding the site of stimulation. Graded potentials may or may not lead to an action potential, depending on the magnitude of depolarization. On the other hand, action potentials exhibit a refractory phase and are not subject to either temporal or spatial summation.
Graded potentials involve chemical, mechanical, or light-gated channels that allow for an influx of sodium ions into the cytosol. In contrast, action potentials involve only voltage-gated ion channels, specifically sodium and potassium. Graded potentials typically last from a few milliseconds to even minutes, while action potential duration ranges between 0.5 – 2 milliseconds.
In summary, graded and action potentials are two distinct phenomena. Graded potentials are subject to modulation by both temporal and spatial summation, while action potentials are not. Graded potentials involve different types of ion channels compared to action potentials. the differences between these two types of potentials is crucial in the complex processes that occur in the nervous system.
-
This question is part of the following fields:
- Neurology
-
-
Question 34
Correct
-
A 35-year-old man complains of severe headaches behind his right eye that last for 1-2 hours at a time. These headaches can occur daily for up to 6 weeks, but then he can go for months without experiencing one. He also experiences eye redness and runny nose alongside his headaches. Despite trying paracetamol and tramadol prescribed by another doctor, he has not found any relief. The pain is so intense that he cannot sleep and if he gets a headache during the day, he is unable to work or socialize. What is the most probable diagnosis?
Your Answer: Cluster headache
Explanation:Cluster headache is a type of headache that mainly affects young men. It is characterized by severe pain behind one eye that can last for up to two hours and occurs repeatedly for a certain period before disappearing for up to a year. Treatment options include inhaled oxygen or sumatriptan, as simple painkillers are usually ineffective.
Tension-type headache, on the other hand, is a headache that feels like a tight band around the head and is not accompanied by sensitivity to light, nausea, or functional impairment. It can be treated with simple painkillers like paracetamol.
Migraine is a recurring headache that may be preceded by an aura and is often accompanied by sensitivity to light, nausea, and functional impairment. Treatment options include simple painkillers and triptans for more severe attacks.
Subarachnoid hemorrhage is a medical emergency that presents as a sudden, severe headache often described as the worst of someone’s life. It requires urgent evaluation with CT brain and possible lumbar puncture to assess the cerebrospinal fluid. A ruptured berry aneurysm is a common cause of subarachnoid hemorrhage.
Meningitis, on the other hand, is associated with fever and systemic symptoms and does not present episodically over a chronic period.
-
This question is part of the following fields:
- Neurology
-
-
Question 35
Incorrect
-
A 17-year-old girl is brought from a school party following an episode of loss of consciousness. She was noted to have jerking of the limbs, frothing at the mouth and was incontinent of urine in the episode. Examination is non-contributory. Blood investigations and CT scan of the brain are normal. She mentions a similar case when on holiday about a year before this episode for which she did not receive treatment.
What is an appropriate step in this patient's management?Your Answer: Refer for MRI of the brain if EEG shows abnormality
Correct Answer: Involve an epilepsy nurse specialist
Explanation:Managing Epilepsy: Key Steps and Considerations
Epilepsy is a complex condition that requires careful management to ensure optimal outcomes for patients. Here are some key steps and considerations that healthcare professionals should keep in mind when treating patients with epilepsy:
1. Involve an epilepsy nurse specialist: Epilepsy nurse specialists can serve as valuable intermediaries between patients and healthcare providers, helping to ensure effective communication and treatment compliance.
2. Advise patients to avoid driving and other high-risk activities: Patients with epilepsy should be advised to avoid driving until they have been seizure-free for a certain amount of time (according to local laws). They should also be cautioned against engaging in other high-risk activities, such as operating heavy machinery or swimming unaccompanied.
3. Refer for diagnostic testing: Patients who have experienced one or more seizures should be referred for diagnostic testing, including blood investigations, EEG, and MRI. These tests can help to identify the underlying cause of seizures and guide treatment decisions.
4. Consider drug treatment: Drug treatment is often necessary for patients with epilepsy, but the choice of medication should be carefully considered based on the patient’s seizure type and individual needs. Sodium valproate and lamotrigine are often used for generalised tonic-clonic seizures, while carbamazepine is first-line for partial seizures.
5. Monitor for side effects: All medications used to treat epilepsy have potential side effects, so patients should be carefully monitored for any adverse reactions. Women of childbearing age should avoid sodium valproate due to the risk of neural tube defects.
6. Consider MRI if EEG shows abnormality: MRI is indicated for patients with new-onset epilepsy or failure of first-line medication, unless there is a clear diagnosis of idiopathic generalised epilepsy. In acute situations, a CT scan may be necessary.
By following these key steps and considerations, healthcare professionals can help to ensure that patients with epilepsy receive the best possible care and management.
-
This question is part of the following fields:
- Neurology
-
-
Question 36
Correct
-
In what way does an ion affect the overall membrane potential of a neuron?
Your Answer: By its valence, concentration gradient and membrane permeability
Explanation:The causes of clubbing are varied and complex. Clubbing is a medical condition that affects the fingers and toes, causing them to become enlarged and rounded. Although the exact cause of clubbing is not fully understood, it is commonly associated with respiratory, gastrointestinal, and cardiovascular disorders.
Among the cardiovascular causes of clubbing, two main conditions stand out: infective endocarditis and tetralogy of Fallot. Tetralogy of Fallot is a congenital heart disorder that is characterized by four malformations in the heart. These include ventricular septal defect, pulmonary stenosis, over-riding aorta, and right ventricular hypertrophy.
As a result of these malformations, oxygenated and deoxygenated blood mix in the patient’s body, leading to low blood oxygen saturation. This can cause a range of symptoms, including sudden cyanosis followed by syncope, which is commonly referred to as tet spells in children. In older children, squatting can help relieve these symptoms by reducing circulation to the legs and relieving syncope.
Understanding the causes of clubbing is important, particularly for medical examinations, as it can help identify underlying conditions that may require further investigation and treatment. By recognizing the signs and symptoms of clubbing, healthcare professionals can provide appropriate care and support to patients with this condition.
-
This question is part of the following fields:
- Neurology
-
-
Question 37
Correct
-
A 25-year-old female comes to the clinic with sudden onset of left foot drop. Upon examination, it is found that she has weakness in ankle dorsiflexion and eversion. There is also a loss of sensation over the dorsum of her foot. All reflexes are present and plantars flexor. Which nerve is most likely to be affected?
Your Answer: Common peroneal nerve
Explanation:Peroneal Neuropathy
Peroneal neuropathy is a condition that typically manifests as sudden foot drop. When a patient is examined, the weakness in the foot and ankle is limited to dorsiflexion of the ankle and toes, as well as eversion of the ankle. However, the ankle reflex (which is mediated by the tibial nerve) and the knee reflex (which is mediated by the femoral nerve) remain intact. In terms of sensory involvement, the lower two-thirds of the lateral leg and the dorsum of the foot may be affected.
It is important to note that peroneal neuropathy is distinct from other nerve issues that may affect the lower leg and foot. For example, sciatic nerve problems may result in impaired knee flexion, while tibial nerve lesions may lead to weakness in foot flexion and pain on the plantar surface. By the specific symptoms and signs of peroneal neuropathy, healthcare providers can make an accurate diagnosis and develop an appropriate treatment plan.
-
This question is part of the following fields:
- Neurology
-
-
Question 38
Correct
-
A 51-year-old woman sustained a deep posterolateral laceration in her right neck during a car crash. Her right shoulder is now lower than the left and she is unable to lift it against resistance. When attempting to shrug her shoulders, there is no rise in muscle tone under the medial upper border of the right shoulder. Which nerve was affected by the injury?
Your Answer: Spinal accessory nerve
Explanation:Nerves of the Shoulder: Functions and Injuries
The shoulder is a complex joint that relies on several nerves for proper function. Injuries to these nerves can result in a range of deficits, from isolated muscle weakness to more widespread impairments. Here are some of the key nerves involved in shoulder movement:
Spinal Accessory Nerve: This nerve innervates the sternocleidomastoid and trapezius muscles. Damage to the spinal accessory nerve can result in trapezius palsy, which can cause difficulty with shoulder elevation.
Dorsal Scapular Nerve: The dorsal scapular nerve innervates the rhomboid muscles and the levator scapulae. Injury to this nerve can lead to weakness in these muscles, which can affect shoulder blade movement.
Suprascapular Nerve: The suprascapular nerve innervates the supraspinatus muscle, which is part of the rotator cuff. Damage to this nerve can result in weakness or pain during shoulder abduction.
Axillary Nerve: The axillary nerve has both anterior and posterior branches that innervate the deltoid muscle and skin over part of the deltoid. Injury to this nerve can cause weakness or numbness in the shoulder.
Upper Trunk of the Brachial Plexus: The upper trunk of the brachial plexus is a collection of nerves that supply a wider variety of muscles and cutaneous structures. Damage to this area can result in more widespread deficits.
Understanding the functions and potential injuries of these nerves can help healthcare professionals diagnose and treat shoulder problems more effectively.
-
This question is part of the following fields:
- Neurology
-
-
Question 39
Correct
-
A 75-year-old left-handed man with permanent atrial fibrillation comes to the clinic complaining of difficulty finding words and weakness in his right arm and leg. The symptoms appeared suddenly and have persisted for 24 hours. He reports no changes in his vision.
What is the probable diagnosis?Your Answer: Partial anterior circulation syndrome stroke (PACS)
Explanation:Understanding Different Types of Strokes: PACS, TACS, TIA, POCS, and LACS
Strokes can be classified into different types based on the location and severity of the brain damage. Here are some key features of five common types of strokes:
Partial anterior circulation syndrome stroke (PACS): This type of stroke affects a part of the brain’s anterior circulation, which supplies blood to the front of the brain. Symptoms may include motor and speech deficits, but not hemianopia (loss of vision in one half of the visual field).
Total anterior circulation syndrome stroke (TACS): This type of stroke affects the entire anterior circulation, leading to a combination of motor deficit, speech deficit, and hemianopia.
Transient ischaemic attack (TIA): This is a temporary episode of neurological symptoms caused by a brief interruption of blood flow to the brain. Symptoms typically last no longer than 24 hours.
Posterior circulation syndrome stroke (POCS): This type of stroke affects the posterior circulation, which supplies blood to the back of the brain. Symptoms may include brainstem symptoms and signs arising from cranial nerve lesions, cerebellar signs, or ipsilateral motor/sensory deficits.
Lacunar syndrome stroke (LACS): This type of stroke is caused by a small infarct (tissue damage) in the deep brain structures, such as the internal capsule. Symptoms may include isolated motor or sensory deficits.
Understanding the different types of strokes can help healthcare professionals diagnose and treat patients more effectively. If you or someone you know experiences any symptoms of a stroke, seek medical attention immediately.
-
This question is part of the following fields:
- Neurology
-
-
Question 40
Incorrect
-
A 16-year-old student presents to the Emergency Department with complaints of headache, neck stiffness, and photophobia. During the examination, a purpuric rash is observed on the trunk and limbs.
What condition is this patient at risk for?Your Answer: Zollinger–Ellison syndrome
Correct Answer: Waterhouse–Friderichsen syndrome
Explanation:Medical Syndromes and Their Characteristics
Waterhouse–Friderichsen Syndrome: This syndrome is caused by acute meningococcal sepsis due to Neisseria meningitidis. It can lead to sepsis, disseminated intravascular coagulation (DIC), endotoxic shock, and acute primary adrenal failure.
Zollinger–Ellison Syndrome: This syndrome results from a gastrinoma, which leads to recurrent peptic ulcers.
Osler–Weber–Rendu Disease: Also known as hereditary haemorrhagic telangiectasia, this disease results in multiple telangiectasias and arteriovenous shunting of blood.
Fitz–Hugh–Curtis Syndrome: This is a rare complication of pelvic inflammatory disease, resulting in liver capsule inflammation.
Cushing Syndrome: This syndrome is due to excess cortisol, which causes hypertension, central obesity, striae, a moon face, and muscle weakness.
-
This question is part of the following fields:
- Neurology
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Secs)