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  • Question 1 - A 65-year-old patient complains of back pain that extends to the left leg....

    Correct

    • A 65-year-old patient complains of back pain that extends to the left leg. The patient reports decreased sensation on the lateral aspect of the left calf and lateral foot. Which nerve roots are likely to be affected in this case?

      Your Answer: L5-S1

      Explanation:

      L5 and S1 Radiculopathy

      L5 radiculopathy is the most common type of radiculopathy that affects the lumbosacral spine. It is characterized by back pain that radiates down the lateral aspect of the leg and into the foot. On the other hand, S1 radiculopathy is identified by pain that radiates down the posterior aspect of the leg and into the foot from the back.

      When examining a patient with S1 radiculopathy, there may be a reduction in leg extension (gluteus maximus), foot eversion, plantar flexion, and toe flexion. Sensation is also generally reduced on the posterior aspect of the leg and the lateral foot.

      It is important to note that both L5 and S1 radiculopathy can cause significant discomfort and affect a patient’s quality of life. Proper diagnosis and management are crucial in addressing these conditions. Patients are advised to seek medical attention if they experience any symptoms related to radiculopathy.

    • This question is part of the following fields:

      • Neurology
      248.8
      Seconds
  • Question 2 - A 15-year-old boy is brought to his GP by his mother due to...

    Incorrect

    • A 15-year-old boy is brought to his GP by his mother due to complaints of bilateral leg weakness and difficulty walking, which has been progressively worsening over the past few years. The patient's father, who passed away from a heart attack four years ago, also had similar issues with his legs. During the examination, the patient was found to have pes cavus, bilateral foot drop, and a stamping gait. Additionally, he had bilateral areflexia and flexor plantar responses, as well as glove-and-stocking sensory loss to the ankle. What is the most likely diagnosis?

      Your Answer: Peripheral vascular disease

      Correct Answer: Charcot–Marie–Tooth

      Explanation:

      Neurological Conditions: A Comparison

      Charcot–Marie–Tooth Syndrome, Subacute Combined Degeneration of the Cord, Chronic Idiopathic Demyelinating Polyneuropathy (CIDP), Old Polio, and Peripheral Vascular Disease are all neurological conditions that affect the peripheral nervous system. However, each condition has distinct clinical features and diagnostic criteria.

      Charcot–Marie–Tooth Syndrome is a hereditary sensorimotor polyneuropathy that presents with foot drop, pes cavus, scoliosis, and stamping gait. A strong family history supports the diagnosis.

      Subacute Combined Degeneration of the Cord is mostly due to vitamin B12 deficiency and presents with a loss of proprioception and vibration sense, spasticity, and hyperreflexia. Risk factors include malabsorption problems or being vegan.

      Chronic Idiopathic Demyelinating Polyneuropathy (CIDP) causes peripheral neuropathy that is mainly motor. It is associated with anti-GM1 antibody, motor conduction block on nerve conduction studies, and elevated protein in the cerebrospinal fluid. It can be treated with intravenous immunoglobulin, prednisolone, plasmapheresis, and azathioprine.

      Old Polio presents with a lower motor neuron pattern of weakness without sensory signs. The signs are often asymmetrical, and the lower limbs are more commonly affected than the upper limbs. Patients may have contractures and fixed flexion deformities from long-standing immobility.

      Peripheral Vascular Disease is accompanied by a history of pain, often in the form of calf claudication on walking, and is unlikely to cause the clinical signs described in this case.

    • This question is part of the following fields:

      • Neurology
      56.2
      Seconds
  • Question 3 - A 65-year-old female presents with a three month history of headaches, shoulder pain...

    Incorrect

    • A 65-year-old female presents with a three month history of headaches, shoulder pain and weight loss. Over this time she has lost approximately 6 kg in weight.

      She describes early morning stiffness of the shoulders. Also, she has become aware of frontal headaches and has noticed tenderness of the scalp particularly when she combs her hair. She has little in her past medical history, she is a lifelong non-smoker and takes no medication.

      During examination, she appears to be in good health with a blood pressure of 126/88 mmHg and a BMI of 23.4. Neurological examination is normal though she is tender over the shoulders and scalp.

      Which of the following investigations would you select for this patient?

      Your Answer: Thyroid function tests

      Correct Answer: Erythrocyte sedimentation rate (ESR)

      Explanation:

      Temporal arthritis/Polymyalgia Rheumatica: A Condition of Unknown Aetiology

      This condition, which is of unknown aetiology, typically affects the elderly and is associated with inflammation of the extracranial arteries. It is characterized by weight loss, proximal muscle stiffness and tenderness, headaches, and scalp tenderness. Elevated inflammatory markers, particularly erythrocyte sedimentation rate (ESR) and C reactive protein, are usually associated with it. Temporal arthritis may also be diagnosed through biopsy of the inflamed temporal artery, although false negatives may occur as the disease may patchily affect the artery.

      It is important to recognize and treat the disease early to reduce morbidity and prevent blindness due to involvement of the optic arteries with retinal ischemia. The condition usually rapidly improves with steroid therapy, and the disease may be monitored through reduction of ESR.

    • This question is part of the following fields:

      • Neurology
      13.9
      Seconds
  • Question 4 - What are the reasons for having dilated pupils? ...

    Incorrect

    • What are the reasons for having dilated pupils?

      Your Answer: Argyll Robertson pupil

      Correct Answer: Ethylene glycol poisoning

      Explanation:

      Causes of Dilated and Small Pupils

      Dilated pupils can be caused by various factors such as Holmes-Adie (myotonic) pupil, third nerve palsy, and drugs or poisons like atropine, CO, and ethylene glycol. On the other hand, small pupils can be caused by Horner’s syndrome, old age, pontine hemorrhage, Argyll Robertson pupil, and drugs or poisons like opiates and organophosphates.

      Holmes-Adie (myotonic) pupil and third nerve palsy are conditions that affect the muscles that control the size of the pupil. Meanwhile, drugs and poisons like atropine, CO, and ethylene glycol can cause dilation of the pupils as a side effect. On the other hand, Horner’s syndrome, old age, pontine hemorrhage, Argyll Robertson pupil, and drugs or poisons like opiates and organophosphates can cause the pupils to become smaller.

    • This question is part of the following fields:

      • Neurology
      19.7
      Seconds
  • Question 5 - A 65-year-old man has experienced three instances of temporary blindness in his right...

    Incorrect

    • A 65-year-old man has experienced three instances of temporary blindness in his right eye. He has a regular heart rate of 88 beats per minute in sinus rhythm. What is the most suitable test to diagnose the condition?

      Your Answer: Fasting lipid profile

      Correct Answer: Carotid duplex ultrasonography

      Explanation:

      Carotid Duplex Ultrasonography for Atherosclerotic Stenosis

      Carotid duplex ultrasonography is an investigation used to identify significant stenosis or occlusive lesions in the internal carotid artery caused by atherosclerosis. This condition can lead to amaurosis fugax, temporary paresis, aphasia, or sensory deficits. Fundoscopic examination may reveal bright yellow cholesterol emboli in patients with retinal involvement. Although carotid duplex is not arranged directly from primary care, healthcare professionals should have an of investigations that may be arranged by secondary care and be able to discuss this with patients in more general terms, including indications.

    • This question is part of the following fields:

      • Neurology
      15.5
      Seconds
  • Question 6 - What is the type of cell that utilizes its Ciliary to assist in...

    Incorrect

    • What is the type of cell that utilizes its Ciliary to assist in the movement of cerebrospinal fluid throughout the central nervous system of vertebrates?

      Your Answer: Oligodendrocytes

      Correct Answer: Ependymal cells

      Explanation:

      The Functions of Cerebrospinal Fluid and the Roles of Different Types of Nervous System Cells

      The cerebrospinal fluid (CSF) is a clear and colourless fluid that circulates in the subarachnoid space, ventricular system of the brain, and central canal of the spinal cord. It provides the brain and spinal cord with mechanical and immunological buoyancy, chemical/temperature protection, and intracranial pressure control. The circulation of CSF within the central nervous system is facilitated by the beating of the Ciliary of ependymal cells, which line the brain ventricles and walls of the central canal. Therefore, ependymal cells are responsible for this function.

      Different types of nervous system cells have distinct roles in supporting the nervous system. Astrocytes provide biochemical support to blood-brain barrier endothelial cells, supply nutrients to nervous tissue, maintain extracellular ion balance, and aid in repairing traumatic injuries. Microglial cells are involved in immune defence of the central nervous system. Oligodendrocytes generate myelin sheaths on neurones of the central nervous system, while Schwann cells generate myelin sheaths on neurones of the peripheral nervous system.

      In summary, the CSF plays crucial roles in protecting and supporting the central nervous system, and ependymal cells are responsible for its circulation. Different types of nervous system cells have distinct functions in supporting the nervous system, including biochemical support, immune defence, and myelin sheath generation.

    • This question is part of the following fields:

      • Neurology
      84.6
      Seconds
  • Question 7 - A 35-year-old man presents to the doctor’s office with complaints of double vision,...

    Correct

    • A 35-year-old man presents to the doctor’s office with complaints of double vision, drooping eyelids, and difficulty with speaking, chewing, and swallowing. He reports feeling well in the morning without weakness, but as the day progresses, he experiences increasing fatigue and weakness. Additionally, he notes muscle weakness after exercise that improves with rest. On physical examination, there is no muscle fasciculation, atrophy, or spasticity, and all reflexes are normal. Sensation is intact, and his pupils are equal and reactive to light. What autoantibodies are responsible for this patient's condition?

      Your Answer: Acetylcholine receptors

      Explanation:

      Autoimmune Diseases and Associated Antibodies

      Myasthenia gravis, systemic lupus erythematosus, Becker and Duchenne muscular dystrophy, multiple sclerosis, and Lambert-Eaton syndrome are all autoimmune diseases that involve the production of specific antibodies. Myasthenia gravis is characterised by the presence of acetylcholine receptor antibodies, while SLE is associated with antibodies to double-stranded DNA and anti-Smith antibodies. Antibodies to dystrophin are linked to muscular dystrophy, and those to myelin are involved in multiple sclerosis. Finally, antibodies to the presynaptic calcium receptor are associated with Lambert-Eaton syndrome. Understanding the specific antibodies involved in these diseases can aid in their diagnosis and treatment.

    • This question is part of the following fields:

      • Neurology
      8.1
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  • Question 8 - A 50-year-old homeless individual is brought to the emergency department after being found...

    Correct

    • A 50-year-old homeless individual is brought to the emergency department after being found vomiting. Upon examination, the patient appears confused and disoriented, with unkempt appearance and slurred speech. However, the patient has a Glasgow Coma Scale score of 14. Vital signs include a pulse of 108 bpm, oxygen saturation of 94% on air, and blood pressure of 124/78 mmHg. Cardiovascular and respiratory exams are normal, with mild epigastric tenderness on abdominal exam. The patient has a broad-based gait and bilateral nystagmus with weakness of abduction of the eyes. Reflexes, power, and tone are generally normal with flexor plantar responses. What is the likely diagnosis?

      Your Answer: Wernicke’s encephalopathy

      Explanation:

      Wernicke’s Encephalopathy: A Medical Emergency

      Wernicke’s encephalopathy is a condition caused by thiamine deficiency, which can be life-threatening if not treated urgently. This condition is often seen in alcoholics or malnourished individuals and can even occur during pregnancy due to hyperemesis gravidarum. The classic triad of symptoms includes ataxia, confusion, and ophthalmoplegia.

      It is crucial to differentiate Wernicke’s encephalopathy from alcohol intoxication as the former requires immediate thiamine replacement. The recommended treatment is either oral thiamine 300 mg/24h or, preferably, intravenous Pabrinex. If left untreated, the condition can rapidly progress to irreversible Korsakoff’s psychosis due to haemorrhage into the mamillary bodies.

      In summary, Wernicke’s encephalopathy is a medical emergency that requires prompt recognition and treatment to prevent irreversible neurological damage. It is essential to be aware of the classic triad of symptoms and to differentiate it from alcohol intoxication to ensure appropriate management.

    • This question is part of the following fields:

      • Neurology
      34
      Seconds
  • Question 9 - A 35-year-old female patient, who smokes and is taking the combined oral contraceptive...

    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
      16.8
      Seconds
  • Question 10 - What is the neurotransmitter that opposes the effects of dopamine in the basal...

    Correct

    • What is the neurotransmitter that opposes the effects of dopamine in the basal ganglia?

      Your Answer: Acetylcholine

      Explanation:

      The Role of Dopamine and Acetylcholine in the Extrapyramidal Motor System

      The basal ganglia is a complex structure in the brain that plays a crucial role in regulating and controlling the extrapyramidal motor system. Within the basal ganglia, there are two types of neurons that work together to maintain proper motor function: dopamine-producing neurons and acetylcholine-producing neurons.

      The substantia nigra, a structure within the basal ganglia, is rich in dopamine-producing neurons. Dopamine exerts an excitatory effect on the extrapyramidal motor system, facilitating movement. On the other hand, acetylcholine exerts an inhibitory effect on the extrapyramidal motor system.

      When both sets of neurons are functioning properly, the extrapyramidal motor system operates normally. However, if either set of neurons is malfunctioning, there can be an excess of inhibition or excitation of the extrapyramidal motor system, resulting in neurological dysfunction.

      One example of this is Parkinson’s disease, which is characterized by a loss of dopaminergic activity in the substantia nigra. This leads to bradykinesia and rigidity in patients. the role of dopamine and acetylcholine in the extrapyramidal motor system is crucial for and treating neurological disorders that affect motor function.

    • This question is part of the following fields:

      • Neurology
      23.4
      Seconds
  • Question 11 - What is the most common visual field defect associated with multiple sclerosis? ...

    Correct

    • What is the most common visual field defect associated with multiple sclerosis?

      Your Answer: Central scotoma

      Explanation:

      Visual Field Defects and Their Causes

      Central scotoma refers to a reduction in vision at the point of fixation, which can interfere with central vision. This condition is often caused by a lesion between the optic nerve head and the chiasm and is commonly associated with retrobulbar neuritis and optic atrophy. Tunnel vision, on the other hand, occurs in conditions such as glaucoma, retinitis pigmentosa, and retinal panphotocoagulation. These conditions cause a loss of peripheral vision, resulting in a narrow visual field.

      Another visual field defect is an increased blind spot, which is often caused by papilloedema. This condition can lead to optic atrophy and is characterized by an enlargement of the blind spot. Finally, optic chiasma compression can cause bitemporal hemianopia, which is a loss of vision in both temporal fields. This condition is often caused by tumors or other lesions that compress the optic chiasm. these different visual field defects and their causes is important for diagnosing and treating vision problems.

      Overall, it is important to note that any changes in vision should be promptly evaluated by a healthcare professional. Early detection and treatment of visual field defects can help prevent further vision loss and improve overall quality of life.

    • This question is part of the following fields:

      • Neurology
      17.7
      Seconds
  • Question 12 - A 9-year-old boy comes to his general practitioner complaining of severe pain in...

    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 flexion at the distal interphalangeal joint of the little finger

      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
      17.8
      Seconds
  • Question 13 - Which of the following combinations of age and percentage of hearing loss is...

    Incorrect

    • Which of the following combinations of age and percentage of hearing loss is incorrect for the overall population?

      Your Answer:

      Correct Answer: Aged 80-89: approximately 50% affected

      Explanation:

      Age and Hearing Loss

      As people age, the likelihood of experiencing hearing loss increases. In fact, the percentage of the population with a significant hearing loss rises with each passing decade. For those in the 80-89-year-old age group, it is estimated that between 70-80% of them will have a degree of hearing loss greater than 25 dB. This means that the majority of individuals in this age range will have difficulty hearing and may require hearing aids or other assistive devices to communicate effectively. It is important for individuals of all ages to take steps to protect their hearing, such as avoiding loud noises and wearing ear protection when necessary, in order to minimize the risk of hearing loss as they age.

    • This question is part of the following fields:

      • Neurology
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  • Question 14 - A 20-year-old man arrives at the Emergency Department with an ‘ape hand’ deformity...

    Incorrect

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

      Your Answer:

      Correct Answer: Sensation to the second and third digits

      Explanation:

      Understanding Nerve Injuries: Implications for Sensation and Movement

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

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

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

    • This question is part of the following fields:

      • Neurology
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  • Question 15 - What is the definition of Nissl bodies? ...

    Incorrect

    • What is the definition of Nissl bodies?

      Your Answer:

      Correct Answer: Granules of rough endoplasmic reticulum

      Explanation:

      Nissl Bodies: Stacks of Rough Endoplasmic Reticulum

      Nissl bodies are named after the German neurologist Franz Nissl and are found in neurones following a selective staining method known as Nissl staining. These bodies are composed of stacks of rough endoplasmic reticulum and are a major site of neurotransmitter synthesis, particularly acetylcholine, in the neurone. Therefore, the correct answer is that Nissl bodies are granules of rough endoplasmic reticulum. It is important to note that the other answer options are incorrect as they refer to entirely different organelles.

    • This question is part of the following fields:

      • Neurology
      0
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  • Question 16 - A 29-year-old woman presents to the Emergency Department with a sudden-onset headache that...

    Incorrect

    • A 29-year-old woman presents to the Emergency Department with a sudden-onset headache that began 12 hours ago. She describes it as ‘an explosion’ and ‘the worst headache of her life’. She denies any vomiting or recent trauma and has not experienced any weight loss. On examination, there are no cranial nerve abnormalities. A CT scan of the head shows no abnormalities. She has no significant medical or family history. The pain has subsided with codeine, and she wants to be discharged.

      What is the most appropriate course of action for this patient?

      Your Answer:

      Correct Answer: Lumbar puncture

      Explanation:

      Management of Suspected Subarachnoid Haemorrhage: Importance of Lumbar Puncture

      When a patient presents with signs and symptoms suggestive of subarachnoid haemorrhage (SAH), it is crucial to confirm the diagnosis through appropriate investigations. While a CT scan of the head is often the first-line investigation, it may not always detect an SAH. In such cases, a lumbar puncture can be a valuable tool to confirm the presence of blood in the cerebrospinal fluid.

      Xanthochromia analysis, which detects the presence of oxyhaemoglobin and bilirubin in the cerebrospinal fluid, can help differentiate between traumatic and non-traumatic causes of blood in the fluid. To ensure the accuracy of the test, the lumbar puncture should be performed at least 12 hours after the onset of headache, and the third sample should be sent for xanthochromia analysis.

      In cases where an SAH is suspected, it is crucial not to discharge the patient without further investigation. Overnight observation may be an option, but it is not ideal as it delays diagnosis and treatment. Similarly, prescribing analgesia may provide symptomatic relief but does not address the underlying issue.

      The best course of action in suspected SAH is to perform a lumbar puncture to confirm the diagnosis and initiate appropriate management. Early diagnosis and treatment can prevent further damage and improve outcomes for the patient.

    • This question is part of the following fields:

      • Neurology
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  • Question 17 - A 35-year-old woman comes to her General Practitioner complaining of sudden onset of...

    Incorrect

    • A 35-year-old woman comes to her General Practitioner complaining of sudden onset of complete right-sided facial weakness that started yesterday. There are no other neurological symptoms observed during the examination. The patient denies any hearing loss and reports only drooling of saliva. Other than that, she is healthy and has no other complaints. An ear examination reveals no abnormalities.
      What is the probable diagnosis?

      Your Answer:

      Correct Answer: Bell's Palsy

      Explanation:

      Understanding Bell’s Palsy and Differential Diagnoses

      Bell’s palsy is a sudden, unexplained facial nerve paralysis that affects one side of the face. It is more common in individuals with certain risk factors, such as diabetes, obesity, and upper respiratory tract infections. Symptoms include facial muscle weakness, drooling, speech difficulties, dry mouth, numbness, and ear pain. Treatment focuses on preventing complications, such as eye irritation, and can include eye ointment, lubricating drops, sunglasses, and a soft-food diet. Recovery typically occurs within a few weeks to several months.

      Differential diagnoses for Bell’s palsy include stroke, acoustic neuroma, Ramsay-Hunt syndrome, and neurosarcoidosis. Stroke typically spares the forehead muscles, while acoustic neuroma presents with hearing loss, tinnitus, and balance problems. Ramsay-Hunt syndrome is a complication of shingles and includes a vesicular rash, fever, and hearing loss. Neurosarcoidosis is rare and associated with systemic disease. A thorough evaluation is necessary to differentiate these conditions from Bell’s palsy.

    • This question is part of the following fields:

      • Neurology
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  • Question 18 - A 68-year-old man presents to the general practitioner (GP) with visual complaints in...

    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:

      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
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  • Question 19 - You see a 92-year-old lady in clinic. Over the past 3 months, her...

    Incorrect

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

      Your Answer:

      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
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  • Question 20 - A 20-year-old female underwent an appendicectomy and was administered an antiemetic for her...

    Incorrect

    • A 20-year-old female underwent an appendicectomy and was administered an antiemetic for her nausea and vomiting. However, she is now experiencing an oculogyric crisis and has a protruding tongue. Which antiemetic is the most probable cause of her symptoms?

      Your Answer:

      Correct Answer: Metoclopramide

      Explanation:

      Extrapyramidal Effects of Antiemetic Drugs

      Anti-nausea medications such as metoclopramide, domperidone, and cyclizine can have extrapyramidal effects, which involve involuntary muscle movements. Metoclopramide is known to cause acute dystonic reactions, which can result in facial and skeletal muscle spasms and oculogyric crisis. These effects are more common in young girls and women, as well as the elderly. However, they typically subside within 24 hours of stopping treatment with metoclopramide.

      On the other hand, domperidone is less likely to cause extrapyramidal effects because it does not easily cross the blood-brain barrier. Cyclizine is also less likely to cause these effects, making it a safer option for those who are susceptible to extrapyramidal reactions. It is important to discuss any concerns about potential side effects with a healthcare provider before starting any new medication.

    • This question is part of the following fields:

      • Neurology
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Neurology (6/12) 50%
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