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  • Question 1 - A 68-year-old man comes to the clinic with a 3-year history of postural...

    Incorrect

    • A 68-year-old man comes to the clinic with a 3-year history of postural instability, frequent falls and cognitive decline. He exhibits hypomania, bradykinesia of the right upper limb, brisk reflexes, especially on the right-hand side, occasional myoclonus and a shuffling gait. He is unable to imitate basic hand gestures with his right hand. During the examination, the patient displays some sensory loss and apraxia.
      What is the probable diagnosis?

      Your Answer: Idiopathic Parkinson’s disease

      Correct Answer: Corticobasal syndrome

      Explanation:

      Neurological Disorders and Their Characteristics

      Corticobasal Syndrome: This rare progressive neurological disorder is characterized by asymmetrical cortical syndrome, gait unsteadiness, falls, parkinsonism, apraxia, and alien limb syndrome. Unfortunately, there is no known treatment for this disorder, and the prognosis is poor, with a life expectancy of 6-8 years from diagnosis.

      Supranuclear Gaze Palsy: This Parkinson’s plus syndrome presents with symmetrical parkinsonism, slow saccades (especially vertical), and a limitation of eye movements.

      Idiopathic Parkinson’s Disease: While this disease may present as asymmetrical at onset, it tends to involve both sides after 6 years. The presence of cortical signs such as hyperreflexia, apraxia, and myoclonus would be atypical.

      Alzheimer’s Disease: This is the most common pathology in patients with cognitive decline, but it presents with prominent cognitive decline, and basal ganglia features are atypical.

      Sporadic Creutzfeldt-Jakob Disease (CJD): This rapidly progressive disorder leads to akinetic mutism and death within a year, with a median of 6 months.

    • This question is part of the following fields:

      • Neurology
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  • Question 2 - A 50-year-old man reports experiencing fatigue that worsens towards the end of the...

    Correct

    • A 50-year-old man reports experiencing fatigue that worsens towards the end of the day. He has also been struggling with swallowing and finds repetitive movements challenging. What is the probable cause of these symptoms?

      Your Answer: Antibodies against acetylcholine receptors

      Explanation:

      Autoimmune Conditions and their Mechanisms

      Myasthenia gravis is an autoimmune condition characterized by autoantibodies against acetylcholine receptors of the post-synaptic neuronal membranes of skeletal muscle. This inhibits the binding of acetylcholine, blocking neuronal transmission and resulting in muscle weakness. Diagnosis is made through serum testing for antibodies against the acetylcholine receptor, and treatment involves acetylcholinesterase inhibitors and immunomodulating drugs.

      In Lambert-Eaton myasthenic syndrome, autoantibodies to presynaptic calcium channel blockers are found, often in association with small cell lung cancer. Demyelinating diseases such as multiple sclerosis are caused by the destruction of the myelin sheath surrounding neuronal axons.

      Understanding Autoimmune Conditions and their Mechanisms

    • This question is part of the following fields:

      • Neurology
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  • Question 3 - A 10-year-old girl is referred to the neurologist by her GP. She loves...

    Incorrect

    • A 10-year-old girl is referred to the neurologist by her GP. She loves playing basketball, but is worried because her teammates have been teasing her about her appearance. They have been making fun of her in the locker room because of the spots she has under her armpits and around her groin. They have also been teasing her about her height, as she is the tallest girl on the team. During a skin examination, the doctor notices evidence of inguinal and axillary freckling, as well as 9 coffee-colored spots on her arms, legs, and chest. An eye exam reveals iris hamartomas.

      What is the mode of inheritance for the underlying condition?

      Your Answer: It is inherited in an autosomal-dominant fashion; all cases are familial

      Correct Answer: It is inherited in an autosomal-dominant fashion; de novo presentations are common

      Explanation:

      Neurofibromatosis type I (NF-1) is caused by a mutation in the neurofibromin gene on chromosome 17 and is inherited in an autosomal-dominant pattern. De novo presentations are common, meaning that around 50% of cases occur in individuals without family history. To make a diagnosis, at least two of the seven core features must be present, with two or more neurofibromas or one plexiform neurofibroma being one of them. Other features associated with NF-1 include short stature and learning difficulties, but these are not necessary for diagnosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 4 - You are requested to evaluate a 15-year-old Caucasian girl who has been feeling...

    Correct

    • You are requested to evaluate a 15-year-old Caucasian girl who has been feeling unwell for a few days. She has been experiencing intermittent fevers and chills and complains of extreme fatigue. Suddenly, half an hour before her admission to the hospital, she lost all vision in her left eye.

      During the examination, the patient appears pale and unwell. Her vital signs are as follows: temperature 38.5°C, pulse 120/minute, regular, blood pressure 100/55 mmHg, and respiratory rate 22/minute. A pansystolic murmur is audible at the apex and lower left sternal border. Both lungs are clear.

      The right pupil reacts normally to light, but there is no reaction from the left pupil, which remains fixed and dilated. The patient has complete loss of vision in the left eye, and the left fundus appears paler than the right, without papilloedema. The only additional finding on examination was a paronychia on her right thumb, and light pressure on the nail bed was very uncomfortable.

      Investigations reveal the following results: Hb 109 g/L (115-165), WBC 14.1 ×109/L (4-11), Neutrophils 9.0 ×109/L (1.5-7), Lymphocytes 4.8 ×109/L (1.5-4), Monocytes 0.29 ×109/L (0-0.8), Eosinophils 0.01 ×109/L (0.04-0.4), and Platelets 550 ×109/L (150-400).

      What is the most crucial investigation to determine the cause of her illness?

      Your Answer: Blood cultures

      Explanation:

      Complications of Chronic Paronychia

      Chronic paronychia can lead to serious complications such as osteomyelitis and endocarditis. The most common causative organism for these complications is Staphylococcus aureus. Endocarditis can cause emboli, which are fragments of vegetation that can block or damage blood vessels in any part of the body. This can result in severe consequences such as blindness, stroke, or paralysis.

      To properly assess and manage a patient with chronic paronychia and its complications, several investigations may be necessary. However, the most crucial immediate investigations are blood cultures and echocardiography. These tests can help identify the causative organism and determine the extent of damage to the heart valves. Early diagnosis and treatment are essential to prevent further complications and improve the patient’s prognosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 5 - A 52-year-old woman presents to her general practitioner (GP), complaining of bleeding gums...

    Incorrect

    • A 52-year-old woman presents to her general practitioner (GP), complaining of bleeding gums every time she brushes her teeth. She reports that this is very concerning to her and has gotten to the point where she has stopped brushing her teeth.
      Her past medical history is significant for hypertension, for which she takes lisinopril. She takes no anticoagulants or antiplatelet medication.
      Her observations are as follows:
      Temperature 37.1°C
      Blood pressure 140/90 mmHg
      Heart rate 68 bpm
      Respiratory rate 16 breaths/min
      Oxygen saturation (SpO2) 98% (room air)
      Examination of the oral cavity reveals red, swollen gingiva, with bleeding easily provoked with a periodontal probe.
      Which of the following is the next best step?

      Your Answer: Epstein–Barr virus testing

      Correct Answer: Referral to a neurologist

      Explanation:

      Medical Recommendations for Gingival Overgrowth

      Gingival overgrowth is a condition where the gum tissues grow excessively, leading to the formation of pockets that can harbor bacteria and cause inflammation. This condition can be caused by certain medications like phenytoin, calcium channel blockers, and ciclosporin. Here are some medical recommendations for managing gingival overgrowth:

      Referral to a Neurologist: If the patient is taking antiepileptic medication, a neurologist should review the medication to determine if it is causing the gingival overgrowth.

      Avoid Brushing Teeth: Although brushing can exacerbate bleeding, not brushing can lead to poor oral hygiene. The cause of the gingival overgrowth needs to be addressed.

      Epstein–Barr Virus Testing: Patients with oral hairy leukoplakia may benefit from Epstein–Barr virus testing.

      Pregnancy Test: A pregnancy test is not indicated in patients with gingival overgrowth unless medication is not the likely cause.

      Vitamin K: Vitamin K is indicated for patients who require warfarin reversal for supratherapeutic international normalized ratios (INRs). It is not necessary for patients who are clinically stable and not actively bleeding.

    • This question is part of the following fields:

      • Neurology
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  • Question 6 - A 16-year-old boy spends the night out with his buddies, drinking 7 pints...

    Incorrect

    • A 16-year-old boy spends the night out with his buddies, drinking 7 pints of beer and a few shots of whiskey. He dozes off in his friend's kitchen with his arm hanging over the back of a chair. The next morning, he experiences tenderness in his right armpit area and is unable to straighten his fingers. What other symptom is he likely to exhibit with this injury?

      Your Answer:

      Correct Answer: Numbness over the dorsal aspect of the right hand between the thumb and index finger

      Explanation:

      Understanding Hand Numbness and Weakness: A Guide to Nerve Supply

      Hand numbness and weakness can be caused by nerve injuries in various locations. The radial nerve, a branch of the brachial plexus, can be injured in the axillary region, humerus, or forearm, resulting in numbness over the dorsal aspect of the hand between the thumb and index finger. The ulnar nerve supplies the little finger and adductor pollicis, while the median nerve innervates the palm and radial lumbricals. Understanding the nerve supply can aid in diagnosing and treating hand numbness and weakness.

    • This question is part of the following fields:

      • Neurology
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  • Question 7 - A 70-year-old man presents with symptoms including poor sleep. He reports an itching...

    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:

      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
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  • Question 8 - A 50-year old man has significant tics, but his language, memory and insight...

    Incorrect

    • A 50-year old man has significant tics, but his language, memory and insight are only mildly to moderately impaired. He also has prominent depression and a butterfly pattern in the caudate nucleus on computed tomography (CT) scan.
      Which is the most likely form of dementia in this patient?

      Your Answer:

      Correct Answer: Dementia due to Huntington’s disease

      Explanation:

      Types of Dementia and their Characteristics

      Dementia is a broad term used to describe a decline in cognitive function that affects daily activities. There are several types of dementia, each with its own unique characteristics.

      Dementia due to Huntington’s disease is an autosomal dominant triplet repeat disease affecting chromosome 4. It usually presents in middle-aged patients with movement disorders (chorea) and progresses to seizures, dementia and death.

      Vascular dementia occurs in a stepwise fashion, with occlusive events leading to sudden new losses of function. Patients develop frontal release and localising neurologic signs relatively early.

      Dementia due to Parkinson’s disease is characterised by loss of dopaminergic cells in the substantia nigra. It also presents with bradykinesia, rigidity, cogwheeling and shuffling gait.

      Alzheimer’s disease has an insidious onset with gradual, continuous progression. Cognitive and language dysfunction occur early, with motor dysfunction and cortical release signs only appearing after diffuse cortical damage has occurred.

      Dementia due to normal pressure hydrocephalus is characterised by the classical triad of dementia, shuffling gait and incontinence. This condition results from blockage of the normal drainage of the cerebrospinal fluid.

      Early recognition and aggressive treatment for cardiovascular disease may slow progression of vascular dementia. Although the changes of vascular dementia are irreversible, the other types of dementia have no cure.

    • This question is part of the following fields:

      • Neurology
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  • Question 9 - A 15-year-old patient, with learning difficulties and poorly controlled epilepsy, is admitted following...

    Incorrect

    • A 15-year-old patient, with learning difficulties and poorly controlled epilepsy, is admitted following a tonic−clonic seizure which resolved after the administration of lorazepam by a Casualty officer. Twenty minutes later, a further seizure occurred that again ceased with lorazepam. A further 10 minutes later, another seizure takes place.
      What commonly would be the next step in the management of this patient?

      Your Answer:

      Correct Answer: Phenytoin

      Explanation:

      Managing Status Epilepticus: Medications and Treatment Options

      Epilepsy is a manageable condition for most patients, but in some cases, seizures may not self-resolve and require medical intervention. In such cases, benzodiazepines like rectal diazepam or intravenous lorazepam are commonly used. However, if seizures persist, other drugs like iv phenytoin may be administered. Paraldehyde is rarely used, and topiramate is more commonly used for seizure prevention. If a patient experiences status epilepticus, informing the intensive care unit may be appropriate, but the priority should be to stop the seizure with appropriate medication.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - A 67-year-old man is brought to the Neurology clinic by his wife because...

    Incorrect

    • A 67-year-old man is brought to the Neurology clinic by his wife because he has had 4 months of progressively worsening dysarthria, gait instability, intention tremor and memory loss. Electroencephalography (EEG) is performed and is significant for triphasic spikes, and cerebrospinal fluid (CSF) is obtained, which shows an elevated 14-3-3 protein. The patient’s clinical course continues to deteriorate, and he dies 7 months after his initial presentation. A researcher obtains permission to procure a brain biopsy specimen to confirm the diagnosis and contribute to a repository of similar diseases.
      What secondary structure would the researcher expect to find in the abnormal brain tissue?

      Your Answer:

      Correct Answer: Proteinaceous β sheets

      Explanation:

      Secondary Structures in Proteins and Nucleic Acids

      Proteins and nucleic acids are essential biomolecules that perform various functions in living organisms. These molecules have unique structural features that enable them to carry out their functions. One such feature is the secondary structure, which refers to the local folding patterns of the molecule.

      Proteinaceous β sheets are a type of secondary structure that is associated with prion disorders such as Creutzfeldt–Jakob disease. Prions are infectious protein molecules that can convert normal cellular prion protein into an abnormal form that exists as β sheets.

      Nucleic acid hairpin loops are another type of secondary structure that has functional properties in DNA and RNA molecules. These structures are formed when a single strand of nucleic acid folds back on itself to form a loop.

      Proteinaceous α helices are a common non-pathological secondary structure of proteins. These structures are formed when the polypeptide chain twists into a helical shape.

      Nucleic acid pseudoknots are secondary structures that have functional properties in DNA and RNA molecules. These structures are formed when two regions of a single strand of nucleic acid fold back on each other and form a knot-like structure.

      Proteinaceous α sheets are theoretical structures that could represent an intermediate between α helices and β sheets. These structures have not been observed in nature but are predicted based on computational models.

      In summary, secondary structures play an important role in the function and stability of proteins and nucleic acids. Understanding these structures is essential for understanding the molecular mechanisms of biological processes.

    • This question is part of the following fields:

      • Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (1/5) 20%
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