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

    Correct

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

      Your Answer: Frontal lobe

      Explanation:

      Pick’s Disease: A Rare Form of Dementia

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

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

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

    • This question is part of the following fields:

      • Neurology
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  • Question 2 - A 35-year-old man presents with a 4-month history of declining physical performance at...

    Correct

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

      Your Answer: Wilson’s disease

      Explanation:

      Differential Diagnosis for a Patient with Liver Failure and Neurological Symptoms

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

    • This question is part of the following fields:

      • Neurology
      19.3
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  • Question 3 - A 50-year-old man has been referred to a neurologist by his GP due...

    Incorrect

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

      Your Answer:

      Correct Answer: Progressive non-fluent aphasia (PNFA)

      Explanation:

      Different Types of Aphasia and Their Characteristics

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

    • This question is part of the following fields:

      • Neurology
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  • Question 4 - A 42-year-old male accountant suddenly collapsed at work, complaining of a severe headache...

    Incorrect

    • A 42-year-old male accountant suddenly collapsed at work, complaining of a severe headache and nausea. He had been feeling fine in the days leading up to this incident. He had a medical history of hypertension and took regular medication for it. He did not smoke or drink alcohol.

      Upon arrival at the Emergency department, the patient had a Glasgow coma scale score of 12/15 (motor 6, vocal 3, eyes 3) and nuchal rigidity. His blood pressure was 145/85 mmHg, pulse was 90 beats per minute and regular, and temperature was 37.1°C. Heart sounds were normal and the chest appeared clear.

      During cranial nerve examination, a left dilated unreactive pupil with oculoparesis of the left medial rectus was observed. Fundoscopy showed no abnormalities. There were no obvious focal neurological signs on examining the peripheral nervous system, although both plantar responses were extensor.

      A lumbar puncture was performed, revealing straw-colored fluid with the following results:
      - Opening pressure: 15 cmH2O (normal range: 6-18)
      - CSF white cell count: 6 cells per ml (normal range: <5)
      - CSF red cell count: 1450 cells per ml (normal range: <5)
      - CSF protein: 0.46 g/L (normal range: 0.15-0.45)
      - Cytospin: Negative for cells

      What is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Posterior communicating artery aneurysm

      Explanation:

      The Oculomotor Nerve and its Effects on Eye Movement and Pupil Size

      The oculomotor nerve nucleus complex is located in the midbrain and is responsible for controlling the movement of several eye muscles. Motor neurons from this complex project to the ipsilateral medial rectus, inferior rectus, and inferior oblique muscles, as well as the contralateral superior rectus. Additionally, a central nucleus innervates the levator palpebrae superioris bilaterally, so damage to this area can result in bilateral ptosis.

      If the oculomotor nerve is damaged during its course, it can result in ipsilateral ptosis and restrict movement of the eye in certain directions. The effect on the pupil can vary depending on the location of the lesion. However, compression of the nerve, such as by a tumor or aneurysm, can result in an acute total third nerve palsy with a dilated unreactive pupil. This is because the parasympathetic nerve fibers that innervate the iris are carried on the outside of the nerve bundle, causing pupillary dilation early on.

      Interestingly, third nerve lesions caused by infarction in patients over 50 years old with diabetes or hypertension often spare the pupil. This means that the pupil remains reactive despite the damage to the nerve. the effects of oculomotor nerve damage can help diagnose and treat various eye conditions.

    • This question is part of the following fields:

      • Neurology
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  • Question 5 - A 68-year-old retired electrical engineer had a gradual decline in initiating and performing...

    Incorrect

    • A 68-year-old retired electrical engineer had a gradual decline in initiating and performing voluntary movements. His face was expressionless and he had tremors, which were particularly obvious when he was sat idle watching tv. He also showed a marked decrease in blinking frequency but had no evidence of dementia.
      What is the most probable diagnosis associated with these symptoms?

      Your Answer:

      Correct Answer: Parkinson’s disease

      Explanation:

      Movement Disorders and Neurodegenerative Diseases: A Brief Overview

      Movement disorders and neurodegenerative diseases are conditions that affect the nervous system and can lead to a range of symptoms, including tremors, rigidity, and difficulty with voluntary movements. Parkinson’s disease is a common neurodegenerative disease that primarily affects the elderly and is characterized by hypokinesia, bradykinesia, resting tremor, rigidity, lack of facial expression, and decreased blinking frequency. While there is no cure for Parkinson’s disease, current treatment strategies involve the administration of L-dopa, which is metabolized to dopamine within the brain and can help stimulate the initiation of voluntary movements.

      Huntington’s disease is another neurodegenerative disease that typically presents in middle-aged patients and is characterized by movement disorders, seizures, dementia, and ultimately death. Alzheimer’s disease is a degenerative disorder that can also lead to dementia, but it is not typically associated with movement disorders like Parkinson’s or Huntington’s disease.

      In rare cases, damage to the subthalamic nucleus can cause movement disorders like ballism and hemiballism, which are characterized by uncontrolled movements of the limbs on the contralateral side of the body. While these conditions are rare, they highlight the complex interplay between different regions of the brain and the importance of understanding the underlying mechanisms of movement disorders and neurodegenerative diseases.

    • This question is part of the following fields:

      • Neurology
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  • Question 6 - A 12-year-old girl comes to the clinic complaining of a headache and homonymous...

    Incorrect

    • A 12-year-old girl comes to the clinic complaining of a headache and homonymous superior quadrantanopia. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Temporal lobe tumour

      Explanation:

      Homonymous Superior Quadrantanopia

      Homonymous superior quadrantanopia is a condition that affects the upper, outer half of one side of the visual field in both eyes. This deficit is typically caused by the interruption of Meyer’s loop of the optic radiation. It can be an early indication of temporal lobe disease or a residual effect of a temporal lobectomy. To remember the different types of quandrantanopias, the mnemonic PITS can be used, which stands for Parietal Inferior Temporal Superior.

    • This question is part of the following fields:

      • Neurology
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  • Question 7 - A 75-year-old female patient comes in with a two-month history of apathy, withdrawal,...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Neurology
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  • Question 8 - What is the correct vertebral level and corresponding structure? ...

    Incorrect

    • What is the correct vertebral level and corresponding structure?

      Your Answer:

      Correct Answer: C4 and bifurcation of the carotid artery

      Explanation:

      Anatomy Landmarks and Openings

      The human body has several anatomical landmarks and openings that are important to know for medical professionals. The carotid artery, which supplies blood to the brain, bifurcates at the level of C4. The manubriosternal joint, also known as the angle of Louis, is located at the T4/5 intervertebral disk level. The aortic opening, which allows the aorta to pass through the diaphragm, is located at T12. The caval opening, which allows the inferior vena cava to pass through the diaphragm, is located at T8. Finally, the oesophageal opening of the diaphragm is located at T10. To remember the order of these openings, medical professionals often use the mnemonic Voice Of America – Vena cava at T8, Oesophagus at T10, and Aorta at T12. these landmarks and openings is crucial for accurate diagnosis and treatment of various medical conditions.

    • This question is part of the following fields:

      • Neurology
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  • Question 9 - A 67-year-old man comes to the Emergency Department complaining of cough, blood in...

    Incorrect

    • A 67-year-old man comes to the Emergency Department complaining of cough, blood in his sputum, and a 3- to 4-cm right-sided supraclavicular lymph node. During the examination, you observe that the right side of his face is dry, and his right eyelid is drooping. What is the most probable location of the patient's pathology?

      Your Answer:

      Correct Answer: Sympathetic chain

      Explanation:

      Understanding the Nerves Involved in Horner Syndrome

      Horner syndrome is a condition characterized by drooping of the eyelids (ptosis) and dryness of the face (anhidrosis), which is caused by interruption of the sympathetic chain. When a patient presents with these symptoms, an apical lung tumor should always be considered. To better understand this condition, it is important to know which nerves are not involved.

      The phrenic nerve, which supplies the diaphragm and is essential for breathing, does not cause symptoms of Horner syndrome when it is affected. Similarly, injury to the brachial plexus, which supplies the nerves of the upper limbs, does not cause ptosis or anhidrosis. The trigeminal nerve, responsible for sensation and muscles of mastication in the face, and the vagus nerve, which regulates heart rate and digestion, are also not involved in Horner syndrome.

      By ruling out these nerves, healthcare professionals can focus on the sympathetic chain as the likely culprit in cases of Horner syndrome.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - A 72-year-old woman with a history of rheumatoid arthritis, hypertension and depression has...

    Incorrect

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

      Your Answer:

      Correct Answer: Flattening of the thenar eminence

      Explanation:

      Understanding the Symptoms of Median Nerve Compression in Carpal Tunnel Syndrome

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

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

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

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

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

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

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

    • This question is part of the following fields:

      • Neurology
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  • Question 11 - A 63-year-old woman comes to the clinic with a complaint of unilateral facial...

    Incorrect

    • A 63-year-old woman comes to the clinic with a complaint of unilateral facial droop. Upon examination, it is noted that she is unable to fully close her left eye. She has no significant medical history but reports having a recent viral upper respiratory tract infection. Her husband is worried that she may have had a stroke, but there are no other focal neurological deficits found except for the isolated left-sided facial nerve palsy.
      What clinical finding would you anticipate during the examination?

      Your Answer:

      Correct Answer: Loss of lacrimation

      Explanation:

      Understanding Bell’s Palsy: Symptoms and Differences from a Stroke

      Bell’s palsy is a condition that affects the facial nerve, causing facial weakness and loss of lacrimation. It is important to distinguish it from a stroke, which can have similar symptoms but different underlying causes. Here are some key points to keep in mind:

      Loss of lacrimation: Bell’s palsy affects the parasympathetic fibers carried in the facial nerve, which are responsible for tear formation. This leads to a loss of lacrimation on the affected side.

      Loss of sensation: The trigeminal nerve carries the nerve fibers responsible for facial sensation, so there will be no sensory deficit in Bell’s palsy.

      Mydriasis: Bell’s palsy does not affect the fibers that supply the pupil, so there will be no mydriasis (dilation of the pupil).

      Facial weakness: Bell’s palsy is a lower motor neuron lesion, which means that innervation to all the facial muscles is interrupted. This leads to left-sided facial weakness without forehead sparing.

      Ptosis: Bell’s palsy affects the orbicularis oculi muscle, which prevents the eye from fully closing. This can lead to ptosis (drooping of the eyelid) and the need for eye patches and artificial tears to prevent corneal ulcers.

      By understanding these symptoms and differences from a stroke, healthcare professionals can provide accurate diagnoses and appropriate treatment for patients with Bell’s palsy.

    • This question is part of the following fields:

      • Neurology
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  • Question 12 - What are the characteristics of Brown-Sequard syndrome? ...

    Incorrect

    • What are the characteristics of Brown-Sequard syndrome?

      Your Answer:

      Correct Answer: There is loss of motor function ipsilateral to the lesion

      Explanation:

      Brown-Sequard Syndrome

      Brown-Sequard syndrome is a condition that results in the loss of motor function on one side of the body and the loss of pain and temperature sensation on the opposite side. This syndrome is typically caused by a penetrating injury to the spinal cord. Despite the severity of the injury, Brown-Sequard syndrome has a relatively good prognosis compared to other incomplete spinal cord syndromes.

      To summarise, Brown-Sequard syndrome is characterised by a specific set of symptoms that occur as a result of a spinal cord injury. While it can be a serious condition, it is important to note that it has a better prognosis than other incomplete spinal cord syndromes. the symptoms and causes of Brown-Sequard syndrome can help individuals better manage and cope with this condition.

    • This question is part of the following fields:

      • Neurology
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  • Question 13 - A 78-year-old retired pharmacist is diagnosed with Alzheimer's disease after being investigated for...

    Incorrect

    • A 78-year-old retired pharmacist is diagnosed with Alzheimer's disease after being investigated for worsening memory problems and getting lost on his way home from the shops. What is associated with a diagnosis of Alzheimer's disease?

      Your Answer:

      Correct Answer: Computed tomography (CT) brain scan = dilation of the sulci and ventricles

      Explanation:

      Diagnostic Tests and Their Relevance in Alzheimer’s Disease

      Computed tomography (CT) brain scan can be used to exclude vascular disease, normal pressure hydrocephalus, and space-occupying lesions in patients with cognitive decline. In pure Alzheimer’s disease, changes consistent with cerebral atrophy, such as dilated sulci and ventricles, are observed.

      Cerebrospinal fluid (CSF) protein levels of 0.5-1.0 g/l are not useful in diagnosing Alzheimer’s disease but may indicate bacterial or viral meningitis.

      An erythrocyte sedimentation rate (ESR) greater than 100 mm/hour is not useful in diagnosing Alzheimer’s disease but may be significant in multiple myeloma or vasculitis.

      Hemoglobin levels of 85 g/l and mean corpuscular volume (MCV) of 112 fl suggest macrocytic anemia, which requires further investigation and is most likely due to B12 or folate deficiency.

      CSF white cells of 100-150 neutrophils/mm3 are not useful in diagnosing Alzheimer’s disease but may indicate meningitis.

      Understanding the Relevance of Diagnostic Tests in Alzheimer’s Disease

    • This question is part of the following fields:

      • Neurology
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  • Question 14 - A 70-year-old hypertensive, diabetic smoker presents with sudden onset unilateral facial weakness, hemiparesis...

    Incorrect

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

      Your Answer:

      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
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  • Question 15 - A 50-year-old truck driver is admitted with a left-sided facial droop, dysphasia and...

    Incorrect

    • A 50-year-old truck driver is admitted with a left-sided facial droop, dysphasia and dysarthria. His symptoms slowly improve and he is very eager to return to work as he is self-employed. After 3 weeks, he has made a complete clinical recovery and neurological examination is normal. As per the guidelines of the Driver and Vehicle Licensing Agency (DVLA), when can he recommence driving his truck?

      Your Answer:

      Correct Answer: 12 months after onset of symptoms

      Explanation:

      Driving Restrictions Following Stroke or TIA

      After experiencing a stroke or transient ischaemic attack (TIA), there are various restrictions on driving depending on the time elapsed since onset of symptoms and the type of vehicle being driven.

      For car drivers, it is recommended that they do not drive for at least 4 weeks after a TIA or stroke. After 1 month, they may resume driving if there has been satisfactory recovery.

      However, for lorry or bus drivers, licences will be revoked for 1 year following a stroke or TIA. After 12 months, relicensing may be offered subject to satisfactory clinical recovery. Functional cardiac testing and medical reports may be required.

      For car drivers who have had a single TIA or stroke, they may resume driving 1 month after the event following satisfactory clinical recovery.

      Overall, it is important to follow these restrictions to ensure the safety of both the driver and others on the road.

    • This question is part of the following fields:

      • Neurology
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  • Question 16 - A 28-year-old pregnant woman is recuperating from cavernous venous sinus thrombosis. The wall...

    Incorrect

    • A 28-year-old pregnant woman is recuperating from cavernous venous sinus thrombosis. The wall of the sinus has impacted all nerves passing through it.
      What is the most prominent clinical indication of cranial nerve impairment caused by this pathological condition?

      Your Answer:

      Correct Answer: Ipsilateral corneal reflex absent

      Explanation:

      Trigeminal Nerve Dysfunction and its Effects on Facial and Oral Function

      The trigeminal nerve is responsible for carrying sensory and motor information from the face and oral cavity to the brain. Dysfunction of this nerve can lead to various symptoms affecting facial and oral function.

      One common symptom is the absence of the ipsilateral corneal reflex, which is carried by the ophthalmic division of the trigeminal nerve. Damage to this nerve interrupts the reflex arc of the corneal reflex.

      Another symptom is the inability to resist forced lateral mandibular excursion with the mouth partially open. This is due to damage to the pterygoid muscles, which are innervated by the motor fibers in the mandibular division of the trigeminal nerve.

      Loss of sensation over the lower lip is also a result of trigeminal nerve dysfunction. The mandibular division of the trigeminal nerve carries general somatic afferent nerves from the lower lip.

      Similarly, loss of somatic sensation over the anterior two-thirds of the tongue is also carried by the trigeminal nerve.

      Lastly, the facial nerve innervates the buccinator muscle, which is responsible for the ability to blow out the cheeks. Damage to this nerve can result in the inability to perform this action.

      Overall, dysfunction of the trigeminal nerve can have significant effects on facial and oral function, highlighting the importance of this nerve in everyday activities.

    • This question is part of the following fields:

      • Neurology
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  • Question 17 - A 54-year-old man with a history of acromegaly presents for a check-up. He...

    Incorrect

    • A 54-year-old man with a history of acromegaly presents for a check-up. He reports experiencing pins and needles in his hands in the early morning hours, and a positive Tinel's sign. Which muscle is most likely to be weak?

      Your Answer:

      Correct Answer: Abductor pollicis brevis

      Explanation:

      Carpal Tunnel Syndrome and Median Nerve Innervation

      Carpal tunnel syndrome is a condition that can cause weakness in the abductor pollicis brevis muscle, which is innervated by the median nerve. This muscle, along with the opponens pollicis, is controlled by the median nerve. The flexor pollicis brevis muscle may also be innervated by either the median or ulnar nerve. In this case, the symptoms suggest carpal tunnel syndrome, which is often associated with acromegaly. Early intervention is crucial in treating carpal tunnel syndrome, as permanent nerve damage can occur if decompression is delayed.

    • This question is part of the following fields:

      • Neurology
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  • Question 18 - An 80-year-old male comes to the clinic with sudden vision loss in his...

    Incorrect

    • An 80-year-old male comes to the clinic with sudden vision loss in his right eye and a relative afferent pupillary defect. He has uncontrolled systemic hypertension and elevated cholesterol levels. What is the probable cause of his condition?

      Your Answer:

      Correct Answer: Retinal vascular occlusion

      Explanation:

      Tips for Answering Tricky Questions in the AKT Exam

      When faced with a tricky question in the AKT exam, it is important to look at the information given and consider which answer may be most likely. One helpful approach is to identify any relevant risk factors and use them to narrow down the options. Additionally, sudden changes in symptoms may be more indicative of certain conditions than chronic symptoms. It is important to remember that it is impossible to know the answer to every question, but by using these strategies, you can improve your hit rate on questions that may initially seem difficult.

    • This question is part of the following fields:

      • Neurology
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  • Question 19 - What condition is Tinel's sign utilized to diagnose? ...

    Incorrect

    • What condition is Tinel's sign utilized to diagnose?

      Your Answer:

      Correct Answer: Carpal tunnel syndrome

      Explanation:

      Tinel’s Sign for Median Nerve Compression

      Tinel’s sign is a diagnostic test used to identify median nerve compression. It involves tapping firmly over the ventral aspect of the wrist, specifically over the carpal tunnel, which produces an electric shock along the course of the median nerve. The test is performed by tapping over the creases on the inner side of the wrist between the two bones on either side of the base of the palm.

      The specificity of Tinel’s sign is high at 94%, meaning that it accurately identifies those with median nerve compression. However, the sensitivity of the test ranges from 44-70%, indicating that it may not identify all cases of median nerve compression. Despite this limitation, Tinel’s sign remains a useful tool for diagnosing median nerve compression and should be used in conjunction with other diagnostic tests.

    • This question is part of the following fields:

      • Neurology
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  • Question 20 - A 55-year-old man comes to the doctor complaining of double vision. Upon examination,...

    Incorrect

    • A 55-year-old man comes to the doctor complaining of double vision. Upon examination, his eye is turned down and out, and he has limited adduction, elevation, and depression of the eye, as well as ptosis. Additionally, his pupil is fixed and dilated. What is the probable diagnosis?

      Your Answer:

      Correct Answer: Third nerve palsy

      Explanation:

      Common Cranial Nerve Palsies and Their Symptoms

      Cranial nerve palsies can cause a variety of symptoms depending on which nerve is affected. Here are some common cranial nerve palsies and their associated symptoms:

      Third Nerve Palsy: This affects the oculomotor nerve and causes the eye to be positioned downward and outward, along with ptosis (drooping eyelid) and mydriasis (dilated pupil).

      Sixth Nerve Palsy: This affects the abducens nerve and causes medial deviation of the eye.

      Fourth Nerve Palsy: This affects the trochlear nerve and causes the eye to look out and down, resulting in vertical or oblique diplopia (double vision). Patients may tilt their head away from the affected side to correct this.

      Horner’s Syndrome: This presents with miosis (constricted pupil), ptosis, and ipsilateral anhidrosis (lack of sweating on one side of the face).

      Fifth Nerve Palsy: This affects the trigeminal nerve, which is responsible for facial sensation and some motor functions related to biting and chewing. It does not affect the eye.

    • This question is part of the following fields:

      • Neurology
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  • Question 21 - What is the mechanism by which a neuron controls its membrane potential? ...

    Incorrect

    • What is the mechanism by which a neuron controls its membrane potential?

      Your Answer:

      Correct Answer: By regulating opening and closing ion channels

      Explanation:

      The Role of Ion Channels in Regulating Membrane Potential

      The membrane potential of a cell is the voltage difference between the inside and outside of the cell membrane. This potential is influenced by the movement of ions across the membrane, which is determined by their valence and concentration gradient. However, the permeability of ions also plays a crucial role in regulating membrane potential. This is achieved through the presence of ion channels that can open and close in response to various stimuli, such as action potentials.

      Neurons, for example, are able to regulate their membrane potential by controlling the opening and closing of ion channels. This allows them to maintain a stable resting potential and respond to changes in their environment. The permeability of ions through these channels is carefully regulated to ensure that the membrane potential remains within a certain range. This is essential for proper neuronal function and communication.

      In summary, the regulation of membrane potential is a complex process that involves the movement of ions across the membrane and the opening and closing of ion channels. This process is critical for maintaining proper cellular function and communication, particularly in neurons.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 66-year-old man is referred to the Elderly Medicine Clinic with a 6-month...

    Incorrect

    • A 66-year-old man is referred to the Elderly Medicine Clinic with a 6-month history of changed behaviour. He has been hoarding newspapers and magazines around the house and refuses to change his clothes for weeks on end. His wife has noticed that he tells the same stories repeatedly, often just minutes apart. He has a new taste for potato crisps and has gained 4 kg in weight. On examination, his mini-mental state examination (MMSE) is 27/30.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Fronto-temporal dementia (FTD)

      Explanation:

      Different Types of Dementia and Their Characteristics

      Dementia is a term used to describe a group of symptoms that affect memory, thinking, and social abilities. There are several types of dementia, each with its own set of characteristics. Here are some of the most common types of dementia and their features:

      1. Fronto-temporal dementia (FTD)
      FTD is characterized by a lack of attention to personal hygiene, repetitive behavior, hoarding/criminal behavior, and new eating habits. Patients with FTD tend to perform well on cognitive tests, but may experience loss of fluency, lack of empathy, ignoring social etiquette, and loss of abstraction.

      2. Diogenes syndrome
      Diogenes syndrome, also known as senile squalor syndrome, is characterized by self-neglect, apathy, social withdrawal, and compulsive hoarding.

      3. Lewy body dementia
      Lewy body dementia is characterized by parkinsonism and visual hallucinations.

      4. Alzheimer’s dementia
      Alzheimer’s dementia shows progressive cognitive decline, including memory loss, difficulty with language, disorientation, and mood swings.

      5. Vascular dementia
      Vascular dementia is characterized by stepwise cognitive decline, usually with a history of vascular disease.

      Understanding the different types of dementia and their characteristics can help with early detection and appropriate treatment.

    • This question is part of the following fields:

      • Neurology
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  • Question 23 - A 25-year-old, fit and healthy woman develops severe headache, confusion and nausea on...

    Incorrect

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

      Your Answer:

      Correct Answer: Descent

      Explanation:

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

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

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

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

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

    • This question is part of the following fields:

      • Neurology
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  • Question 24 - A 25-year-old married shop assistant presents to the Emergency Department with a presumed...

    Incorrect

    • A 25-year-old married shop assistant presents to the Emergency Department with a presumed seizure, where her hands and feet shook and she bit her tongue. This is the second such event in the past 6 months and she was due to see a neurologist in a month’s time. Computed tomography (CT) brain was normal. Electroencephalogram (EEG) was normal, albeit not performed during the ‘seizure’ activity. Her doctor believes she has epilepsy and is keen to commence anticonvulsive therapy. She is sexually active and uses only condoms for protection.
      Which one of the following drugs would be most suitable for this particular patient?

      Your Answer:

      Correct Answer: Lamotrigine

      Explanation:

      Antiepileptic Medications and Pregnancy: Considerations for Women of Childbearing Age

      When it comes to treating epilepsy in women of childbearing age, there are important considerations to keep in mind. Lamotrigine is a good choice for monotherapy, but it can worsen myoclonic seizures. Levetiracetam is preferred for myoclonic seizures, while carbamazepine has an increased risk of birth defects. Sodium valproate is the first-line agent for adults with generalized epilepsy, but it has been linked to neural tube defects in babies. Phenytoin is no longer used as a first-line treatment, but may be used in emergency situations. Clinicians should be aware of these risks and consult resources like the UK Epilepsy and Pregnancy Registry to make informed decisions about treatment.

    • This question is part of the following fields:

      • Neurology
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  • Question 25 - A 20-year-old man complained of a sudden frontal headache accompanied by photophobia. He...

    Incorrect

    • A 20-year-old man complained of a sudden frontal headache accompanied by photophobia. He also experienced neck stiffness and had a temperature of 38°C. What distinguishing feature would indicate a diagnosis of subarachnoid haemorrhage instead of bacterial meningitis?

      Your Answer:

      Correct Answer: A family history of polycystic kidney disease

      Explanation:

      Comparing Risk Factors and Symptoms of Meningitis, SAH, and Cerebral Aneurysms

      Fluctuating levels of consciousness are common symptoms of both meningitis and subarachnoid hemorrhage (SAH). While hypertension is a known risk factor for SAH, diabetes does not increase the risk. On the other hand, opiate abuse is not associated with an increased risk of SAH. Cerebral aneurysms, which are a type of SAH, are often linked to polycystic kidney disease. It is important to understand the different risk factors and symptoms associated with these conditions to ensure prompt diagnosis and treatment. By recognizing these factors, healthcare professionals can provide appropriate care and improve patient outcomes.

    • This question is part of the following fields:

      • Neurology
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  • Question 26 - A previously healthy 72-year-old man reports experiencing intermittent flashes and a curtain-like loss...

    Incorrect

    • A previously healthy 72-year-old man reports experiencing intermittent flashes and a curtain-like loss of lateral vision in his right eye upon waking up this morning, which has since worsened. What is the most probable cause of his symptoms?

      Your Answer:

      Correct Answer: Retinal detachment

      Explanation:

      Retinal Detachment

      Retinal detachment is a serious eye emergency that occurs when the retina’s sensory and pigment layers separate. This condition can be caused by various factors such as congenital malformations, metabolic disorders, trauma, vascular disease, high myopia, vitreous disease, and degeneration. It is important to note that retinal detachment is a time-critical condition that requires immediate medical attention.

      Symptoms of retinal detachment include floaters, a grey curtain or veil moving across the field of vision, and sudden decrease of vision. Early diagnosis and treatment can help prevent permanent vision loss. Therefore, it is crucial to be aware of the risk factors and symptoms associated with retinal detachment to ensure prompt medical attention and treatment.

    • This question is part of the following fields:

      • Neurology
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  • Question 27 - A 40-year-old woman presents to your clinic with complaints of difficulty reading, which...

    Incorrect

    • 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:

      Correct 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
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  • Question 28 - A 50-year-old man reports experiencing fatigue that worsens towards the end of the...

    Incorrect

    • 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:

      Correct 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 29 - The ward nurses express concern about a 46-year-old man who was admitted with...

    Incorrect

    • The ward nurses express concern about a 46-year-old man who was admitted with jaundice yesterday. They discovered him in the linen cupboard, disoriented and searching for his luggage so he could check-out before midday. Upon your arrival, he is still confused and unsteady, with a tachycardia of 120 bpm and nystagmus. However, he poses no immediate danger to himself or others. Which medication would be suitable for this patient?

      Your Answer:

      Correct Answer: Thiamine IV and chlordiazepoxide orally (PO)

      Explanation:

      Treatment Plan for Wernicke’s Encephalopathy in Alcohol Withdrawal

      Wernicke’s encephalopathy is a disorder caused by thiamine deficiency commonly seen in alcohol withdrawal. The triad of ophthalmoplegia, confusion, and ataxia characterizes it. If left untreated, it can lead to Korsakoff syndrome with lasting memory impairment. The following treatment plan is recommended:

      Treatment Plan for Wernicke’s Encephalopathy in Alcohol Withdrawal

      1. Thiamine IV: Parenteral thiamine (Pabrinex®) is required and should be given in a setting where resuscitation facilities are available due to the risk of anaphylaxis. Thiamine is also given prophylactically in alcohol withdrawal.

      2. Chlordiazepoxide PO: Given orally as required (PRN) to control the symptoms of delirium tremens. The dosage should be adjusted according to symptom severity.

      3. Haloperidol IM: Antipsychotic medication such as haloperidol or IM benzodiazepines are not required in this instance where the patient is not at risk to himself or others.

      4. N-acetylcysteine IV: N-Acetylcysteine is used commonly for the treatment of paracetamol overdose. There is no evidence that this patient has a liver impairment as a result of paracetamol overdose.

      5. Propranolol PO: Propranolol is used for the treatment of portal hypertension and although likely, there is no evidence this patient has portal hypertension.

      6. Thiamine IM and midazolam IM: Thiamine is not given IM. There is no indication for IM benzodiazepines as this patient is co-operating with treatment. A chlordiazepoxide withdrawal regime would be better suited to this patient’s needs. This can be given orally.

    • This question is part of the following fields:

      • Neurology
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  • Question 30 - A 40-year-old woman presents to the Neurology Clinic with a complaint of droopy...

    Incorrect

    • A 40-year-old woman presents to the Neurology Clinic with a complaint of droopy eyelids that have been present for the past 6 months. She reports experiencing intermittent double vision that varies in severity. She has also noticed difficulty swallowing her food at times. Upon examination, she displays mild weakness in eyelid closure bilaterally and mild lower facial weakness. Additionally, there is mild weakness in neck flexion and bilateral shoulder abduction. Reflexes are normal throughout, and the remainder of the examination is unremarkable. Electromyography is performed, revealing a 30% decrease in the compound motor action potential (CMAP) upon repetitive nerve stimulation (right abductor pollicis brevis muscle). Single-fibre electromyography shows normal fibre density and jitter. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Autoimmune myasthenia gravis

      Explanation:

      Differentiating Myasthenia Gravis from Other Neuromuscular Disorders

      Myasthenia gravis (MG) is an autoimmune disorder that causes muscle weakness and fatigue. It occurs when antibodies block the acetylcholine receptors at the neuromuscular junction, leading to impaired muscle function. This can be detected through electromyographic testing, which measures fatigability. However, other neuromuscular disorders can present with similar symptoms, making diagnosis challenging.

      Congenital myasthenia gravis is a rare form that occurs in infants born to myasthenic mothers. Guillain-Barré syndrome, although typically presenting with ophthalmoplegia, can also cause muscle weakness and reflex abnormalities. Lambert-Eaton myasthenic syndrome is caused by autoantibodies to voltage-gated calcium channels and is characterized by absent reflexes. Polymyalgia rheumatica, an inflammatory disorder of the soft tissues, can cause pain and weakness in the shoulder girdle but does not affect nerve conduction or facial muscles.

      Therefore, a thorough evaluation and diagnostic testing are necessary to differentiate MG from other neuromuscular disorders.

    • This question is part of the following fields:

      • Neurology
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