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Question 1
Correct
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A 45-year-old patient presents after trauma and exhibits a lack of sensation in the anatomical snuff box. Which nerve is likely responsible for this sensory loss?
Your Answer: Radial nerve
Explanation:Common Nerve Injuries and Their Effects
Radial nerve injury causes a condition known as wrist drop, which is characterized by the inability to extend the wrist and fingers. This injury also results in varying degrees of sensory loss, with the anatomical snuffbox being a common area affected.
On the other hand, median nerve injury leads to the loss of sensation in the thumb, index, middle, and lateral half of the ring finger. This condition can also cause weakness in the muscles that control the thumb, leading to difficulty in grasping objects.
Lastly, ulnar nerve injury results in a claw hand deformity, where the fingers are flexed and cannot be straightened. This injury also causes a loss of sensation over the medial half of the ring finger and little finger.
In summary, nerve injuries can have significant effects on the function and sensation of the hand. It is important to seek medical attention if any of these symptoms are experienced to prevent further damage.
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This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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You are asked to give a presentation to a group of third-year medical students about the different types of dementia and how they may present.
Which of the following is characteristic of frontotemporal dementia?Your Answer: Rapid progressive loss of memory and cognitive abilities
Correct Answer: Confabulation and repetition
Explanation:Understanding Fronto-Temporal Dementia: Symptoms and Features
Fronto-temporal dementia is a complex disorder that affects both the frontal and temporal lobes of the brain. Its diagnosis can be challenging, especially in the early stages of the disease. To better understand this condition, it is helpful to examine its symptoms and features based on the affected brain regions.
Frontal lobe dysfunction is characterized by changes in personality and behavior, such as loss of tact and concern for others, disinhibition, emotional instability, distractibility, impulsivity, and fixed attitudes. However, some patients may exhibit opposite behaviors and become increasingly withdrawn.
Temporal lobe dysfunction, on the other hand, affects speech and language abilities, leading to dysphasia, confabulation, repetition, and difficulty finding words and names (semantic dementia).
Other features of fronto-temporal dementia include earlier onset (typically between 40-60 years old), slow and insidious progression, relatively preserved memory in the early stages, and loss of executive function as the disease advances. Unlike Alzheimer’s disease, hallucinations, paranoia, and delusions are rare, and personality and mood remain largely unaffected.
It is important to note that fronto-temporal dementia can present differently in late onset cases (70-80 years old) and does not typically involve bradykinesia, a hallmark symptom of Parkinson’s disease. Rapid progressive loss of memory and cognitive abilities is also not typical of fronto-temporal dementia, as the disease tends to progress slowly over time.
In summary, understanding the symptoms and features of fronto-temporal dementia can aid in its early detection and management.
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This question is part of the following fields:
- Neurology
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Question 3
Correct
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A 68-year-old man is admitted to the Emergency Department having been picked up by a patrolling police car. He was found wandering around a roundabout in his nightgown, and when stopped, had no recollection of where he lived or of his own name. A mini-mental assessment reveals that he is disorientated to time and place and has poor memory. Physical examination is unremarkable. A full history is taken following contact with his wife and she reports that her husband has been suffering from worsening memory and cognition. A differential diagnosis includes dementia. Investigations are requested.
What is the most common cause of dementia in the United Kingdom?Your Answer: Alzheimer’s disease
Explanation:Types of Dementia: Causes, Symptoms, and Management
Dementia is a progressive loss of cognitive function that affects millions of people worldwide. There are several types of dementia, each with its own causes, symptoms, and management strategies. In this article, we will discuss the most common types of dementia, including Alzheimer’s disease, Huntington’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal dementia.
Alzheimer’s Disease
Alzheimer’s disease is the most common cause of dementia, accounting for approximately 60% of cases in the UK. It is a progressive brain disorder that causes memory loss, disorientation, altered personality, and altered cognition. While there is no cure for Alzheimer’s disease, treatment with antioxidants and certain drugs, such as anticholinesterases, can slow or reduce cognitive decline.Huntington’s Disease
Huntington’s disease is a rare autosomal dominant condition that affects approximately 12 per 100,000 of the UK population. It can cause dementia at any stage of the illness.Vascular Dementia
Vascular dementia is the second most common cause of dementia, accounting for approximately 17% of cases in the UK. It is caused by reduced blood flow to the brain, which can result from conditions such as stroke or high blood pressure.Dementia with Lewy Bodies
Dementia with Lewy bodies is a type of dementia that accounts for approximately 4% of cases. It is characterized by abnormal protein deposits in the brain, which can cause hallucinations, movement disorders, and cognitive decline.Frontotemporal Dementia
Frontotemporal dementia is a rare form of dementia that accounts for around 2% of cases in the UK. It typically causes personality and behavioral changes, such as apathy, disinhibition, and loss of empathy.In conclusion, dementia is a complex and challenging condition that can have a significant impact on individuals and their families. While there is no cure for most types of dementia, early diagnosis and management can help to slow the progression of symptoms and improve quality of life.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A 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: Myotonic 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.
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This question is part of the following fields:
- Neurology
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Question 5
Incorrect
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A 67-year-old patient comes in with a spastic hemiparesis on the left side, a positive Babinski sign on the left, and facial paralysis on the left lower two-thirds. However, the patient's speech is fluent and they have normal comprehension of verbal and written commands. Which cerebral artery is likely blocked?
Your Answer: Right middle cerebral
Correct Answer: Left lenticulostriate
Explanation:Pure Motor Stroke
A pure motor stroke is a type of stroke that results in a right hemiparesis, or weakness on one side of the body. This type of stroke is caused by a lesion in the left cerebral hemisphere, which is likely to be a lacunar infarct. The symptoms of a pure motor stroke are purely motor, meaning that they only affect movement and not speech or comprehension.
If the stroke had affected the entire territory of the left middle cerebral artery, then speech and comprehension would also be affected. However, in this case, the lesion is likely to be in the lenticulostriate artery, which has caused infarction of the internal capsule. This leads to a purely motor stroke, where the patient experiences weakness on one side of the body.
the type of stroke a patient has is important for determining the appropriate treatment and management plan. In the case of a pure motor stroke, rehabilitation and physical therapy may be necessary to help the patient regain strength and mobility on the affected side of the body.
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This question is part of the following fields:
- Neurology
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Question 6
Correct
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A lesion in which lobe can result in a change in personality of the individual?
Your Answer: Frontal
Explanation:The Four Lobes of the Brain and Their Functions
The brain is a complex organ that controls all bodily functions and processes. It is divided into four main lobes, each with its own unique functions and responsibilities. The frontal lobe is responsible for behavior, personality, reasoning, planning, movement, emotions, and problem-solving. The temporal lobe is responsible for hearing and memory, specifically the hippocampus. The parietal lobe is responsible for touch, pressure, temperature, and pain perception. Lastly, the occipital lobe is responsible for vision.
In summary, the frontal lobe controls higher-level thinking and decision-making, the temporal lobe is responsible for auditory perception and memory, the parietal lobe is responsible for sensory perception, and the occipital lobe is responsible for vision. the functions of each lobe can help us better understand how the brain works and how it affects our daily lives.
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This question is part of the following fields:
- Neurology
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Question 7
Incorrect
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What distinguishes graded potentials from action potentials?
Your Answer: Action potentials are subject to temporal and spatial summation, while graded potentials are not
Correct 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.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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A 75-year-old female patient comes in with a two-month history of apathy, withdrawal, urinary and faecal incontinence, and anosmia. What is the most probable location of the neurological lesion?
Your Answer: Temporal lobe
Correct Answer: Frontal lobe
Explanation:Frontal Lobe Syndrome
Frontal lobe syndrome is a condition that is characterized by a range of symptoms that affect the frontal lobe of the brain. This condition can present with a variety of symptoms, including personality changes, urinary and faecal incontinence, anosmia, expressive dysphasia, release of primitive reflexes, and epilepsy. In some cases, patients may also experience dementia-like symptoms.
One of the key features of frontal lobe syndrome is the release of primitive reflexes, such as the positive grasp, pout, and palmomental reflexes. These reflexes are typically present in infants, but they may reappear in patients with frontal lobe damage. Additionally, patients with frontal lobe syndrome may experience seizures, which can be a sign of a frontal lobe tumor.
It is important to note that frontal lobe syndrome can be difficult to diagnose, as it can mimic other conditions such as dementia. However, with proper evaluation and testing, doctors can identify the underlying cause of the symptoms and develop an appropriate treatment plan. Overall, frontal lobe syndrome is crucial for early detection and effective management of this condition.
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This question is part of the following fields:
- Neurology
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Question 9
Incorrect
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A 70-year-old man with a history of cardiovascular disease presents with vertigo, difficulty swallowing, and unsteadiness of gait. Upon neurological assessment, he is found to have nystagmus with the quick phase towards the right side and ataxia of the right upper and lower limbs. He reports no hearing loss. There is a loss of pain and temperature sensation on the right side of the face, and the left side of the limbs and trunk. The patient exhibits drooping of the right side of the palate upon eliciting the gag reflex, as well as right-sided ptosis and miosis.
Which vessel is most likely to be affected by thromboembolism given these clinical findings?Your Answer: The right anterior inferior cerebellar artery
Correct Answer: The right posterior inferior cerebellar artery
Explanation:Arterial Territories and Associated Syndromes
The right posterior inferior cerebellar artery is commonly associated with lateral medullary syndrome, which presents with symptoms such as palatal drooping, dysphagia, and dysphonia. The right anterior choroidal artery, which supplies various parts of the brain, can cause contralateral hemiparesis, loss of sensation, and homonymous hemianopia when occluded. Similarly, occlusion of the left anterior choroidal artery can result in similar symptoms. The right labyrinthine artery, a branch of the anterior inferior cerebellar artery, can cause unilateral deafness and vertigo when ischemia occurs. Finally, the right anterior inferior cerebellar artery can lead to ipsilateral facial paresis, vertigo, nystagmus, and hearing loss, as well as facial hemianaesthesia due to trigeminal nerve nucleus involvement. Understanding these arterial territories and associated syndromes can aid in diagnosis and treatment.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A 20-year-old farm worker presents with a two-day history of progressive weakness and tingling in all limbs. He had a recent episode of respiratory symptoms that resolved without treatment. On examination, he has decreased muscle strength in all extremities and absent deep tendon reflexes in the legs. Laboratory results show normal blood counts and electrolytes, as well as elevated CSF protein and normal glucose. What is the likely diagnosis?
Your Answer: Viral encephalitis
Correct Answer: Post-infectious polyradiculopathy
Explanation:Guillain-Barré Syndrome and Peripheral Neuropathy Diagnosis
A history of progressive weakness and loss of tendon reflexes, especially after a recent infection, may indicate Guillain-Barré syndrome, also known as post-infectious polyradiculopathy. It is important to monitor respiratory function regularly, and the best way to do this is by measuring the vital capacity. When diagnosing peripheral neuropathy, a focused clinical assessment that addresses several key issues can significantly narrow down the differential diagnosis.
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This question is part of the following fields:
- Neurology
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