00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A child arrives at the Emergency Department with a petechial rash, headache, neck...

    Correct

    • A child arrives at the Emergency Department with a petechial rash, headache, neck stiffness, and sensitivity to light. You suspect a diagnosis of meningococcal meningitis.
      What is the most suitable initial approach to management?

      Your Answer: Give ceftriaxone 2 g IV

      Explanation:

      Due to the potentially life-threatening nature of the disease, it is crucial to initiate treatment without waiting for laboratory confirmation. Immediate administration of antibiotics is necessary.

      In a hospital setting, the preferred agents for treatment are IV ceftriaxone (2 g for adults; 80 mg/kg for children) or IV cefotaxime (2 g for adults; 80 mg/kg for children). In the prehospital setting, IM benzylpenicillin can be given as an alternative. If there is a history of anaphylaxis to cephalosporins, chloramphenicol is a suitable alternative.

      It is important to prioritize prompt treatment due to the severity of the disease. The recommended antibiotics should be administered as soon as possible to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Neurology
      12.1
      Seconds
  • Question 2 - You are summoned to the resuscitation bay to aid in the care of...

    Incorrect

    • You are summoned to the resuscitation bay to aid in the care of a 45-year-old male who has suffered a traumatic brain injury. What should be included in the initial management of a patient with elevated intracranial pressure (ICP)?

      Your Answer: Active warming of patient

      Correct Answer: Maintain systolic blood pressure >90 mmHg

      Explanation:

      Maintaining adequate blood pressure is crucial in managing increased intracranial pressure (ICP). The recommended blood pressure targets may vary depending on the source. The Scottish Intercollegiate Guidelines Network (SIGN) suggests maintaining an adequate blood pressure, while the 4th edition of the Brain Trauma Foundation recommends maintaining a systolic blood pressure (SBP) above 100 mm Hg for individuals aged 50-69 years (or above 110 mm Hg for those aged 15-49 years) to reduce mortality and improve outcomes.

      When managing a patient with increased ICP, the initial steps should include maintaining normal body temperature to prevent fever, positioning the patient with a 30º head-up tilt, and administering analgesia and sedation as needed. It is important to monitor and maintain blood pressure, using inotropes if necessary to achieve the target. Additionally, preparations should be made to use medications such as Mannitol or hypertonic saline to lower ICP if required. Hyperventilation may also be considered, although it carries the risk of inducing ischemia and requires monitoring of carbon dioxide levels.

      Further Reading:

      Intracranial pressure (ICP) refers to the pressure within the craniospinal compartment, which includes neural tissue, blood, and cerebrospinal fluid (CSF). Normal ICP for a supine adult is 5-15 mmHg. The body maintains ICP within a narrow range through shifts in CSF production and absorption. If ICP rises, it can lead to decreased cerebral perfusion pressure, resulting in cerebral hypoperfusion, ischemia, and potentially brain herniation.

      The cranium, which houses the brain, is a closed rigid box in adults and cannot expand. It is made up of 8 bones and contains three main components: brain tissue, cerebral blood, and CSF. Brain tissue accounts for about 80% of the intracranial volume, while CSF and blood each account for about 10%. The Monro-Kellie doctrine states that the sum of intracranial volumes is constant, so an increase in one component must be offset by a decrease in the others.

      There are various causes of raised ICP, including hematomas, neoplasms, brain abscesses, edema, CSF circulation disorders, venous sinus obstruction, and accelerated hypertension. Symptoms of raised ICP include headache, vomiting, pupillary changes, reduced cognition and consciousness, neurological signs, abnormal fundoscopy, cranial nerve palsy, hemiparesis, bradycardia, high blood pressure, irregular breathing, focal neurological deficits, seizures, stupor, coma, and death.

      Measuring ICP typically requires invasive procedures, such as inserting a sensor through the skull. Management of raised ICP involves a multi-faceted approach, including antipyretics to maintain normothermia, seizure control, positioning the patient with a 30º head up tilt, maintaining normal blood pressure, providing analgesia, using drugs to lower ICP (such as mannitol or saline), and inducing hypocapnoeic vasoconstriction through hyperventilation. If these measures are ineffective, second-line therapies like barbiturate coma, optimised hyperventilation, controlled hypothermia, or decompressive craniectomy may be considered.

    • This question is part of the following fields:

      • Neurology
      63.9
      Seconds
  • Question 3 - A 45-year-old man presents with complaints of headaches. He recently started a new...

    Incorrect

    • A 45-year-old man presents with complaints of headaches. He recently started a new job and spends a significant amount of time on a computer. He admits to feeling more stressed than usual lately. He describes his headaches as a tight band around his head that sometimes extends into his neck. The headaches are more severe towards the end of the day and typically last for a couple of hours. He does not experience any aura, sensitivity to light, or nausea during an episode. The headaches occur approximately 4-5 days per month and are relieved by over-the-counter pain medication.

      What is the most likely diagnosis for this patient?

      Your Answer: Migraine without aura

      Correct Answer: Episodic tension-type headache

      Explanation:

      This patient’s history is indicative of episodic tension-type headache. Chronic tension-type headache is defined as experiencing headaches on more than 15 days per month.

      Migraine with typical aura presents with temporary visual disturbances such as hemianopia or scintillating scotoma that spreads. Migraine without aura must meet the criteria set by the International Headache Society, which are outlined below:

      1. The patient must have at least five attacks that meet criteria 2-4.
      2. The duration of each headache attack should be between 4 and 72 hours.
      3. The headache must have at least two of the following characteristics:
      – Located on one side of the head
      – Pulsating quality
      – Moderate or severe pain intensity
      – Aggravation or avoidance of routine physical activity (e.g., walking or climbing stairs)
      4. During the headache, the patient must experience at least one of the following:
      – Nausea and/or vomiting
      – Sensitivity to light (photophobia) and sound (phonophobia)
      5. The headache should not be attributed to another disorder.

      Medication overuse headache is suspected when a patient uses multiple medications, often at low doses, without experiencing any relief from their headaches. Combination medications containing barbiturates, codeine, and caffeine are frequently involved. The diagnosis can only be confirmed when the symptoms improve after discontinuing the medication.

    • This question is part of the following fields:

      • Neurology
      214.6
      Seconds
  • Question 4 - A 42-year-old man has been brought into the Emergency Department (ED) experiencing seizures...

    Correct

    • A 42-year-old man has been brought into the Emergency Department (ED) experiencing seizures that have lasted for 40 minutes before his arrival. On arrival, he is still having a tonic-clonic seizure. He is a known epileptic and is currently taking phenobarbital for seizure prevention. He has received a single dose of rectal diazepam by the paramedics on the way to the hospital approximately 15 minutes ago. Upon arrival in the ED, intravenous access is established, and a dose of IV lorazepam is administered. After an additional 15 minutes, a fosphenytoin infusion is started. Another 25 minutes have passed, and he has not responded to the previous treatment.

      Which of the following medications would be most appropriate to administer next?

      Your Answer: Thiopental sodium bolus

      Explanation:

      Status epilepticus is a condition characterized by continuous seizure activity lasting for 5 minutes or more without the return of consciousness, or recurrent seizures (2 or more) without a period of neurological recovery in between. In this case, the patient has already received two doses of benzodiazepine and is currently on a phenytoin infusion. However, despite these treatments, the seizures persist, and it has been 20 minutes since the infusion started. At this point, the preferred treatment option is to induce general anesthesia. The induction agents that can be considered include thiopental sodium, propofol, and midazolam. There is no need to administer intravenous thiamine in this situation.

      The management of status epilepticus involves several general measures, which are outlined in the following table:

      1st stage (Early status, 0-10 minutes):
      – Secure the airway and provide resuscitation
      – Administer oxygen
      – Assess cardiorespiratory function
      – Establish intravenous access

      2nd stage (0-30 minutes):
      – Implement regular monitoring
      – Consider the possibility of non-epileptic status
      – Initiate emergency antiepileptic drug (AED) therapy
      – Perform emergency investigations
      – Administer glucose or intravenous thiamine if alcohol abuse or impaired nutrition is suspected
      – Treat severe acidosis if present

      3rd stage (0-60 minutes):
      – Determine the underlying cause of status epilepticus
      – Notify the anesthetist and intensive care unit (ITU)
      – Identify and treat any medical complications
      – Consider pressor therapy if necessary

      4th stage (30-90 minutes):
      – Transfer the patient to the intensive care unit
      – Establish intensive care and EEG monitoring
      – Initiate long-term maintenance AED therapy
      – Perform further investigations as needed, such as brain imaging or lumbar puncture

      Emergency investigations include blood tests for gases, glucose, renal and liver function, calcium and magnesium levels, full blood count (including platelets), blood clotting, and AED drug levels. Serum and urine samples should be saved for future analysis, including toxicology if the cause of convulsive status epilepticus is uncertain. A chest radiograph may be done to evaluate the possibility of aspiration. Additional investigations depend on the clinical circumstances and may include brain imaging or lumbar puncture.

      Monitoring during the management of status epilepticus involves regular neurological observations and measurements of pulse, blood pressure, and temperature.

    • This question is part of the following fields:

      • Neurology
      249.2
      Seconds
  • Question 5 - A 32-year-old man presents with a range of neurological symptoms. He has been...

    Incorrect

    • A 32-year-old man presents with a range of neurological symptoms. He has been experiencing painless double vision over the past day and is becoming worried. Approximately six months ago, he also recalled a two-week period where he had no feeling in his right arm. When directly asked, he also confesses to feeling tired and quite depressed.

      What is the SINGLE most probable diagnosis?

      Your Answer: Depression

      Correct Answer: Multiple sclerosis

      Explanation:

      Multiple sclerosis is a condition characterized by the demyelination of nerve cells in the brain and spinal cord. It is an autoimmune disease mediated by cells and is caused by recurring inflammation. Typically, it presents in early adulthood, with a female to male ratio of 3:2.

      There are several risk factors associated with multiple sclerosis, including being of Caucasian race, living at a greater distance from the equator (as the risk tends to be higher), having a family history of the disease (with 20% of MS patients having an affected relative), and smoking. Interestingly, the rates of relapse tend to decrease during pregnancy.

      There are three main patterns of multiple sclerosis. The most common is relapsing and remitting MS, which is characterized by periods of no symptoms followed by relapses (this is seen in 80% of patients at the time of diagnosis). Another pattern is primary progressive MS, where symptoms develop and worsen from the beginning with few remissions (seen in 10-15% of patients at diagnosis). Lastly, there is secondary progressive MS, which occurs after relapsing/remitting MS. In this pattern, symptoms worsen with fewer remissions, and approximately 50% of those with relapsing/remitting MS will develop this within 10 years of diagnosis.

      The key to diagnosing MS lies in the history of neurological symptoms that are discrete in time and location of the affected body. Patients often experience fatigue and low mood, particularly during a relapse.

    • This question is part of the following fields:

      • Neurology
      95
      Seconds
  • Question 6 - A child develops a palsy of their right arm following a difficult birth....

    Incorrect

    • A child develops a palsy of their right arm following a difficult birth. During the examination, it is observed that there is a lack of shoulder abduction, external rotation, and elbow flexion. The arm is visibly hanging with the elbow extended and the forearm pronated.
      Which nerve root is most likely to have been affected in this situation?

      Your Answer: C8

      Correct Answer: C5

      Explanation:

      Erb’s palsy, also known as Erb-Duchenne palsy, is a condition where the arm becomes paralyzed due to an injury to the upper roots of the brachial plexus. The primary root affected is usually C5, although C6 may also be involved in some cases. The main cause of Erb’s palsy is when the arm experiences excessive force during a difficult childbirth, but it can also occur in adults as a result of shoulder trauma.

      Clinically, the affected arm will hang by the side with the elbow extended and the forearm turned inward (known as the waiter’s tip sign). Upon examination, there will be a loss of certain movements:

      – Shoulder abduction (involving the deltoid and supraspinatus muscles)
      – Shoulder external rotation (infraspinatus muscle)
      – Elbow flexion (biceps and brachialis muscles)

      It is important to differentiate Erb’s palsy from Klumpke’s palsy, which affects the lower roots of the brachial plexus (C8 and T1). Klumpke’s palsy presents with a claw hand due to paralysis of the intrinsic hand muscles, along with sensory loss along the ulnar side of the forearm and hand. If T1 is affected, there may also be the presence of Horner’s syndrome.

    • This question is part of the following fields:

      • Neurology
      13.4
      Seconds
  • Question 7 - A patient who was diagnosed with Parkinson's disease five years ago has experienced...

    Incorrect

    • A patient who was diagnosed with Parkinson's disease five years ago has experienced a sudden and significant deterioration in her functioning. Her motor symptoms are limited to her right arm and leg. She has lost nearly all functionality in her right hand, but there is no noticeable tremor. Additionally, her right arm frequently exhibits involuntary jerking movements and is held in a contracted position. The patient also reports a decline in her memory abilities.

      What is the most probable diagnosis in this case?

      Your Answer: Dementia with Lewy Bodies

      Correct Answer: Corticobasal degeneration

      Explanation:

      The Parkinson-plus syndromes are a group of neurodegenerative disorders that share similar features with Parkinson’s disease but also have additional clinical characteristics that set them apart from idiopathic Parkinson’s disease (iPD). These syndromes include Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal degeneration (CBD), and Dementia with Lewy Bodies (DLB).

      Multiple System Atrophy (MSA) is a less common condition than iPD and PSP. It is characterized by the loss of cells in multiple areas of the nervous system. MSA progresses rapidly, often leading to wheelchair dependence within 3-4 years of diagnosis. Some distinguishing features of MSA include autonomic dysfunction, bladder control problems, erectile dysfunction, blood pressure changes, early-onset balance problems, neck or facial dystonia, and a high-pitched voice.

      To summarize the distinguishing features of the Parkinson-plus syndromes compared to iPD, the following table provides a comparison:

      iPD:
      – Symptom onset: One side of the body affected more than the other
      – Tremor: Typically starts at rest on one side of the body
      – Levodopa response: Excellent response
      – Mental changes: Depression
      – Balance/falls: Late in the disease
      – Common eye abnormalities: Dry eyes, trouble focusing

      MSA:
      – Symptom onset: Both sides equally affected
      – Tremor: Not common but may occur
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Depression
      – Balance/falls: Within 1-3 years
      – Common eye abnormalities: Dry eyes, trouble focusing

      PSP:
      – Symptom onset: Both sides equally affected
      – Tremor: Less common, if present affects both sides
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Personality changes, depression
      – Balance/falls: Within 1 year
      – Common eye abnormalities: Dry eyes, difficulty in looking downwards

      CBD:
      – Symptom onset: One side of the body affected more than the other
      – Tremor: Not common but may occur
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Depression
      – Balance/falls: Within 1-3 years
      – Common eye abnormalities: Dry eyes, trouble focusing

    • This question is part of the following fields:

      • Neurology
      127.4
      Seconds
  • Question 8 - A 6-year-old boy has been brought into the Emergency Department having seizures that...

    Incorrect

    • A 6-year-old boy has been brought into the Emergency Department having seizures that have lasted for 25 minutes prior to his arrival. On arrival, he is continuing to have a tonic-clonic seizure.
      What dose of rectal diazepam is recommended for the treatment of the convulsing child?

      Your Answer:

      Correct Answer: 0.5 mg/kg

      Explanation:

      The recommended dose of rectal diazepam for treating a child experiencing convulsions is 0.5 mg per kilogram of body weight.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 9 - A 62-year-old man presents with right-sided hemiplegia of the limbs, face, and tongue...

    Incorrect

    • A 62-year-old man presents with right-sided hemiplegia of the limbs, face, and tongue and left-sided deficits in motor eye activity. He has a past medical history of hypertension, diabetes, and a previous ischemic stroke. A CT head scan is undertaken, and he is discovered to have suffered a left-sided stroke. He is subsequently admitted under the stroke team.
      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Weber’s syndrome

      Explanation:

      Occlusion of the branches of the basilar artery that supply the midbrain leads to the development of Weber’s syndrome. This condition is characterized by contralateral hemiplegia, which affects the limbs, face, and tongue due to damage to the descending motor tracts within the crus cerebri. Additionally, there are ipsilateral deficits in eye motor activity caused by damage to cranial nerve III.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 10 - A 72 year old male comes to the emergency department with complaints of...

    Incorrect

    • A 72 year old male comes to the emergency department with complaints of vertigo. What signs would indicate a central cause?

      Your Answer:

      Correct Answer: Negative head impulse test

      Explanation:

      A patient with central vertigo would typically show a normal head impulse test result, indicating a normal vestibulo-ocular reflex. However, they would likely have an abnormal alternate cover test result, with a slight vertical correction, suggesting a central lesion like a stroke. A positive Romberg’s test can identify instability related to vertigo but cannot differentiate between peripheral and central causes. On the other hand, a positive Unterberger’s test indicates labyrinth dysfunction but does not indicate a central cause.

      Further Reading:

      Vertigo is a symptom characterized by a false sensation of movement, such as spinning or rotation, in the absence of any actual physical movement. It is not a diagnosis itself, but rather a description of the sensation experienced by the individual. Dizziness, on the other hand, refers to a perception of disturbed or impaired spatial orientation without a false sense of motion.

      Vertigo can be classified as either peripheral or central. Peripheral vertigo is more common and is caused by problems in the inner ear that affect the labyrinth or vestibular nerve. Examples of peripheral vertigo include BPPV, vestibular neuritis, labyrinthitis, and Meniere’s disease. Central vertigo, on the other hand, is caused by pathology in the brain, such as in the brainstem or cerebellum. Examples of central vertigo include migraine, TIA and stroke, cerebellar tumor, acoustic neuroma, and multiple sclerosis.

      There are certain features that can help differentiate between peripheral and central vertigo. Peripheral vertigo is often associated with severe nausea and vomiting, hearing loss or tinnitus, and a positive head impulse test. Central vertigo may be characterized by prolonged and severe vertigo, new-onset headache, recent trauma, cardiovascular risk factors, inability to stand or walk with eyes open, focal neurological deficit, and a negative head impulse test.

      Nystagmus, an involuntary eye movement, can also provide clues about the underlying cause of vertigo. Central causes of vertigo often have nystagmus that is direction-changing on lateral gaze, purely vertical or torsional, not suppressed by visual fixation, non-fatigable, and commonly large amplitude. Peripheral causes of vertigo often have horizontal nystagmus with a torsional component that does not change direction with gaze, disappears with fixation of the gaze, and may have large amplitude early in the course of Meniere’s disease or vestibular neuritis.

      There are various causes of vertigo, including viral labyrinthitis, vestibular neuritis, benign paroxysmal positional vertigo, Meniere’s disease, vertebrobasilar ischemia, and acoustic neuroma. Each of these disorders has its own unique characteristics and may be associated with other symptoms such as hearing loss, tinnitus, or neurological deficits.

      When assessing a patient with vertigo, it is important to perform a cardiovascular and neurological examination, including assessing cranial nerves, cerebellar signs, eye movements, gait, coordination, and evidence of peripheral neuropathy.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 11 - A 3-year-old boy has been brought into the Emergency Department having seizures that...

    Incorrect

    • A 3-year-old boy has been brought into the Emergency Department having seizures that have lasted for 25 minutes prior to his arrival. On arrival, he is continuing to have a tonic-clonic seizure.
      What dose of phenytoin is recommended in the treatment of the convulsing child that reaches that stage of the APLS algorithm?

      Your Answer:

      Correct Answer: 20 mg/kg over 20 minutes

      Explanation:

      If a child who is experiencing convulsions reaches step 3 of the APLS algorithm, it is recommended to prepare a phenytoin infusion. This infusion should be administered at a dosage of 20 mg/kg over a period of 20 minutes.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 12 - A 65-year-old patient who was diagnosed with Parkinson's disease three years ago has...

    Incorrect

    • A 65-year-old patient who was diagnosed with Parkinson's disease three years ago has experienced a rapid deterioration in her overall functioning. She has been experiencing a progressive decline in her cognitive abilities, with severe memory impairment. Additionally, she has been experiencing prominent visual hallucinations and frequent fluctuations in her level of attention and alertness. Although her tremor is relatively mild, it is still present.
      What is the most probable diagnosis for this patient?

      Your Answer:

      Correct Answer: Dementia with Lewy Bodies

      Explanation:

      The Parkinson-plus syndromes are a group of neurodegenerative disorders that share similar features with Parkinson’s disease but also have additional clinical characteristics that set them apart from idiopathic Parkinson’s disease (iPD). These syndromes include Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal degeneration (CBD), and Dementia with Lewy Bodies (DLB).

      Multiple System Atrophy (MSA) is a less common condition than iPD and PSP. It is characterized by the loss of cells in multiple areas of the nervous system. MSA progresses rapidly, often leading to wheelchair dependence within 3-4 years of diagnosis. Some distinguishing features of MSA include autonomic dysfunction, bladder control problems, erectile dysfunction, blood pressure changes, early-onset balance problems, neck or facial dystonia, and a high-pitched voice.

      To summarize the distinguishing features of the Parkinson-plus syndromes compared to iPD, the following table provides a comparison:

      iPD:
      – Symptom onset: One side of the body affected more than the other
      – Tremor: Typically starts at rest on one side of the body
      – Levodopa response: Excellent response
      – Mental changes: Depression
      – Balance/falls: Late in the disease
      – Common eye abnormalities: Dry eyes, trouble focusing

      MSA:
      – Symptom onset: Both sides equally affected
      – Tremor: Not common but may occur
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Depression
      – Balance/falls: Within 1-3 years
      – Common eye abnormalities: Dry eyes, trouble focusing

      PSP:
      – Symptom onset: Both sides equally affected
      – Tremor: Less common, if present affects both sides
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Personality changes, depression
      – Balance/falls: Within 1 year
      – Common eye abnormalities: Dry eyes, difficulty in looking downwards

      CBD:
      – Symptom onset: One side of the body affected more than the other
      – Tremor: Not common but may occur
      – Levodopa response: Minimal response (but often tried in early stages of disease)
      – Mental changes: Depression
      – Balance/falls: Within 1-3 years
      – Common eye abnormalities: Dry eyes, trouble focusing

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 13 - A 35-year-old woman is brought into the emergency department after being hit by...

    Incorrect

    • A 35-year-old woman is brought into the emergency department after being hit by a car while riding her bike. The patient was not wearing a helmet and suffered a head injury from hitting the pavement. She has a significant scalp contusion and appears drowsy. There is a suspicion of increased intracranial pressure. How does intracranial pressure affect cerebral perfusion pressure?

      Your Answer:

      Correct Answer: Cerebral perfusion pressure (CPP) = mean arterial pressure (MAP) - intracranial pressure (ICP)

      Explanation:

      Cerebral perfusion pressure (CPP) is calculated by adding the intracranial pressure (ICP) to the diastolic blood pressure (DBP).

      Further Reading:

      Intracranial pressure (ICP) refers to the pressure within the craniospinal compartment, which includes neural tissue, blood, and cerebrospinal fluid (CSF). Normal ICP for a supine adult is 5-15 mmHg. The body maintains ICP within a narrow range through shifts in CSF production and absorption. If ICP rises, it can lead to decreased cerebral perfusion pressure, resulting in cerebral hypoperfusion, ischemia, and potentially brain herniation.

      The cranium, which houses the brain, is a closed rigid box in adults and cannot expand. It is made up of 8 bones and contains three main components: brain tissue, cerebral blood, and CSF. Brain tissue accounts for about 80% of the intracranial volume, while CSF and blood each account for about 10%. The Monro-Kellie doctrine states that the sum of intracranial volumes is constant, so an increase in one component must be offset by a decrease in the others.

      There are various causes of raised ICP, including hematomas, neoplasms, brain abscesses, edema, CSF circulation disorders, venous sinus obstruction, and accelerated hypertension. Symptoms of raised ICP include headache, vomiting, pupillary changes, reduced cognition and consciousness, neurological signs, abnormal fundoscopy, cranial nerve palsy, hemiparesis, bradycardia, high blood pressure, irregular breathing, focal neurological deficits, seizures, stupor, coma, and death.

      Measuring ICP typically requires invasive procedures, such as inserting a sensor through the skull. Management of raised ICP involves a multi-faceted approach, including antipyretics to maintain normothermia, seizure control, positioning the patient with a 30º head up tilt, maintaining normal blood pressure, providing analgesia, using drugs to lower ICP (such as mannitol or saline), and inducing hypocapnoeic vasoconstriction through hyperventilation. If these measures are ineffective, second-line therapies like barbiturate coma, optimised hyperventilation, controlled hypothermia, or decompressive craniectomy may be considered.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 14 - A 35-year-old woman has experienced a fracture of the left humerus. During examination,...

    Incorrect

    • A 35-year-old woman has experienced a fracture of the left humerus. During examination, it is found that she has weakness in extending her wrist and metacarpophalangeal joints, leading to wrist drop and an inability to grip with her left hand. However, she still has preserved extension of the elbow. Additionally, there is a loss of sensation over the dorsal aspect of the forearm from below the elbow to the 1st dorsal interosseous.
      Which nerve has been damaged in this particular case?

      Your Answer:

      Correct Answer: Radial nerve

      Explanation:

      Radial nerve injuries often occur in conjunction with fractures of the humerus. The most common cause of a radial nerve palsy is external compression or trauma to the radial nerve as it passes through the spiral groove in the middle of the humerus.

      There are several factors that can lead to damage of the radial nerve in the spiral groove. These include trauma, such as a fracture in the middle of the humerus, compression known as Saturday night palsy, and iatrogenic causes like injections.

      When the radial nerve is injured within the spiral groove, it results in weakness of the wrist and metacarpophalangeal joints. However, elbow extension is not affected because the branches to the triceps and anconeus muscles originate before the spiral groove. The interphalangeal joints remain unaffected as well, as they are supplied by the median and ulnar nerves. Sensory loss will be experienced over the dorsal aspect of the forearm, extending from below the elbow to the 1st dorsal interosseous.

      In contrast, injury to the radial nerve in the axilla will also cause weakness of elbow extension and sensory loss in the distribution of the more proximal cutaneous branches. This helps distinguish it from injury in the spiral groove.

      In the forearm, the posterior interosseous branch of the radial nerve can also be damaged. This can occur due to injury to the radial head or entrapment in the supinator muscle under the arcade of Frohse. However, this type of injury can be easily distinguished from injury in the spiral groove because there is no sensory involvement and no wrist drop, thanks to the preservation of the extensor carpi radialis longus. Nonetheless, there will still be weakness in the wrist and fingers.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 15 - A middle-aged patient experiences a stroke that leads to impairment in Broca's area....

    Incorrect

    • A middle-aged patient experiences a stroke that leads to impairment in Broca's area. What will be the consequences of the damage to Broca's area?

      Your Answer:

      Correct Answer: Expressive aphasia

      Explanation:

      Broca’s area is situated in the frontal lobe of the dominant cerebral hemisphere. Specifically, it can be located in the posterior section of the inferior frontal gyrus, and it comprises of the pars opercularis and the pars triangularis.

      Broca’s area is responsible for regulating the motor functions involved in speech production. It facilitates the creation of words through its connections with neighboring motor areas, which stimulate the muscles of the larynx, mouth, tongue, and soft palate.

      If there is damage to Broca’s area, it will lead to speech paralysis and expressive aphasia, commonly referred to as Broca’s aphasia.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 16 - A 65 year old male is brought to the emergency department by a...

    Incorrect

    • A 65 year old male is brought to the emergency department by a family member. The family member informs you that the patient experiences episodes of cognitive decline that last for a few days. During these episodes, the patient struggles to remember the names of friends or family members and often forgets what he is doing. The family member also mentions that the patient seems to have hallucinations, frequently asking about animals in the house and people in the garden who are not actually there. Upon examination, you observe muscle rigidity and a tremor. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Dementia with Lewy bodies

      Explanation:

      Dementia with Lewy bodies (DLB) is characterized by several key features, including spontaneous fluctuations in cognitive abilities, visual hallucinations, and Parkinsonism. Visual hallucinations are particularly prevalent in DLB and Parkinson’s disease dementia, which are considered to be part of the same spectrum. While visual hallucinations can occur in other forms of dementia, they are less frequently observed.

      Further Reading:

      Dementia is a progressive and irreversible clinical syndrome characterized by cognitive and behavioral symptoms. These symptoms include memory loss, impaired reasoning and communication, personality changes, and reduced ability to carry out daily activities. The decline in cognition affects multiple domains of intellectual functioning and is not solely due to normal aging.

      To diagnose dementia, a person must have impairment in at least two cognitive domains that significantly impact their daily activities. This impairment cannot be explained by delirium or other major psychiatric disorders. Early-onset dementia refers to dementia that develops before the age of 65.

      The most common cause of dementia is Alzheimer’s disease, accounting for 50-75% of cases. Other causes include vascular dementia, dementia with Lewy bodies, and frontotemporal dementia. Less common causes include Parkinson’s disease dementia, Huntington’s disease, prion disease, and metabolic and endocrine disorders.

      There are several risk factors for dementia, including age, mild cognitive impairment, genetic predisposition, excess alcohol intake, head injury, depression, learning difficulties, diabetes, obesity, hypertension, smoking, Parkinson’s disease, low social engagement, low physical activity, low educational attainment, hearing impairment, and air pollution.

      Assessment of dementia involves taking a history from the patient and ideally a family member or close friend. The person’s current level of cognition and functional capabilities should be compared to their baseline level. Physical examination, blood tests, and cognitive assessment tools can also aid in the diagnosis.

      Differential diagnosis for dementia includes normal age-related memory changes, mild cognitive impairment, depression, delirium, vitamin deficiencies, hypothyroidism, adverse drug effects, normal pressure hydrocephalus, and sensory deficits.

      Management of dementia involves a multi-disciplinary approach that includes non-pharmacological and pharmacological measures. Non-pharmacological interventions may include driving assessment, modifiable risk factor management, and non-pharmacological therapies to promote cognition and independence. Drug treatments for dementia should be initiated by specialists and may include acetylcholinesterase inhibitors, memantine, and antipsychotics in certain cases.

      In summary, dementia is a progressive and irreversible syndrome characterized by cognitive and behavioral symptoms. It has various causes and risk factors, and its management involves a multi-disciplinary approach.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 17 - You review a middle-aged man on the Clinical Decision Unit (CDU) who is...

    Incorrect

    • You review a middle-aged man on the Clinical Decision Unit (CDU) who is known to have Parkinson’s disease. Currently, he takes a combination of levodopa and selegiline, and his symptoms are reasonably well controlled. He has recently been diagnosed with a different condition, and he wonders if this could be related to his Parkinson’s disease.

      Which of the following conditions is most likely to be associated with Parkinson’s disease?

      Your Answer:

      Correct Answer: Depression

      Explanation:

      Parkinson’s disease is often accompanied by two prevalent diseases, namely dementia and depression. Dementia is observed in approximately 20 to 40% of individuals diagnosed with Parkinson’s disease. On the other hand, depression is experienced by around 45% of patients with Parkinson’s disease.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 18 - A 65-year-old woman comes in with right-sided weakness and difficulty speaking. Her ROSIER...

    Incorrect

    • A 65-year-old woman comes in with right-sided weakness and difficulty speaking. Her ROSIER score is 3. She weighs 60 kg.
      What is the appropriate dosage of alteplase to give?

      Your Answer:

      Correct Answer: 63mg

      Explanation:

      Alteplase (rt-pA) is recommended for the treatment of acute ischaemic stroke in adults if it is administered as soon as possible within 4.5 hours of the onset of stroke symptoms. It is important to exclude intracranial haemorrhage through appropriate imaging techniques before starting the treatment. The initial dose of alteplase is 0.9 mg/kg, with a maximum dose of 90 mg. This dose should be given intravenously over a period of 60 minutes. The first 10% of the dose should be administered through intravenous injection, while the remaining dose should be given through intravenous infusion. For a patient weighing 70 kg, the recommended dose would be 63 mg. For more information, please refer to the NICE guidelines on stroke and transient ischaemic attack in individuals over 16 years old.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 19 - A 32-year-old woman presents with a diagnosis of cluster headache.
    Which SINGLE clinical feature...

    Incorrect

    • A 32-year-old woman presents with a diagnosis of cluster headache.
      Which SINGLE clinical feature would be inconsistent with this diagnosis?

      Your Answer:

      Correct Answer: Ipsilateral mydriasis

      Explanation:

      Cluster headaches primarily affect men in their 20s, with a male to female ratio of 6:1. Smoking is also a contributing factor to the development of cluster headaches. These headaches typically occur in clusters, hence the name, lasting for a few weeks every year or two. The pain experienced is intense and localized, often felt around or behind the eye. It tends to occur at the same time each day and can lead to restlessness, with some patients resorting to hitting their head against a wall or the floor in an attempt to distract themselves from the pain.

      In addition to the severe pain, cluster headaches also involve autonomic symptoms. These symptoms include redness and inflammation of the conjunctiva on the same side as the headache, as well as a runny nose and excessive tearing on the affected side. The pupil on the same side may also constrict, and there may be drooping of the eyelid on that side as well.

      Overall, cluster headaches are a debilitating condition that predominantly affects young men. The pain experienced is excruciating and can lead to extreme measures to alleviate it. The associated autonomic symptoms further contribute to the discomfort and distress caused by these headaches.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 20 - A 68-year-old individual presents with rest tremor, rigidity, and bradykinesia. A diagnosis of...

    Incorrect

    • A 68-year-old individual presents with rest tremor, rigidity, and bradykinesia. A diagnosis of Parkinson's disease is determined.
      Parkinson's disease primarily occurs due to a loss of dopaminergic cells in which anatomical regions?

      Your Answer:

      Correct Answer: Midbrain

      Explanation:

      Parkinson’s disease is primarily characterized by the degeneration of cells in the substantia nigra, a region located in the midbrain. The most severely affected part is the pars compacta, which plays a crucial role in motor control. As a result, there is a significant decrease in the activity of cells that secrete dopamine.

      The main symptoms of Parkinson’s disease include tremors that occur when the body is at rest, rigidity in the muscles, and bradykinesia, which refers to a slowness in movement. These symptoms can greatly impact a person’s ability to perform everyday tasks and can progressively worsen over time.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 21 - A 3-year-old boy is brought to the Emergency Department by his parents following...

    Incorrect

    • A 3-year-old boy is brought to the Emergency Department by his parents following a brief self-limiting seizure at home. He was diagnosed with an ear infection by his pediatrician yesterday and started on antibiotics. Despite this, he has been experiencing intermittent high fevers throughout the day. After a thorough evaluation, you determine that he has had a febrile convulsion.
      What is his estimated likelihood of experiencing another convulsion within the next 24 hours?

      Your Answer:

      Correct Answer: 10%

      Explanation:

      Febrile convulsions are harmless, generalized seizures that occur in otherwise healthy children who have a fever due to an infection outside the brain. To diagnose febrile convulsions, the child must be developing normally, the seizure should last less than 20 minutes, have no complex features, and not cause any lasting abnormalities.

      The prognosis for febrile convulsions is generally positive. There is a 30 to 50% chance of experiencing recurrent febrile convulsions, with a 10% risk of recurrence within the first 24 hours. The likelihood of developing long-term epilepsy is around 6%.

      Complex febrile convulsions are characterized by certain factors. These include focal seizures, seizures lasting longer than 15 minutes, experiencing more than one convulsion during a single fever episode, or the child being left with a focal neurological deficit.

      Overall, febrile convulsions are typically harmless and do not cause any lasting damage.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 22 - A 42-year-old woman comes in with a headache that feels like she has...

    Incorrect

    • A 42-year-old woman comes in with a headache that feels like she has been punched in the head. The headache throbs towards the back of the head and is accompanied by nausea. A CT scan of the head is performed, and it confirms a diagnosis of subarachnoid hemorrhage.
      In which of the following areas will blood have accumulated?

      Your Answer:

      Correct Answer: Between the arachnoid mater and pia mater

      Explanation:

      The meninges refer to the protective tissue layers that surround the brain and spinal cord. These layers, along with the cerebrospinal fluid (CSF), work together to safeguard the central nervous system structures from physical harm and provide support for the blood vessels in the brain and skull.

      The meninges consist of three distinct layers: the outermost layer called the dura mater, the middle layer known as the arachnoid mater, and the innermost layer called the pia mater.

      There are three types of hemorrhage that involve the meninges. The first is extradural (or epidural) hemorrhage, which occurs when blood accumulates between the dura mater and the skull. The second is subdural hemorrhage, where blood gathers between the dura mater and the arachnoid mater. Lastly, subarachnoid hemorrhage happens when blood collects in the subarachnoid space, which is the area between the arachnoid mater and the pia mater.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 23 - A toddler develops a palsy of his left leg following a fall. On...

    Incorrect

    • A toddler develops a palsy of his left leg following a fall. On examination, there is a loss of hip abduction, external rotation and knee flexion. The leg is noticeably dragging with the knee extended and the foot turned inward.
      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Erb’s palsy

      Explanation:

      Erb’s palsy, also known as Erb-Duchenne palsy, is a condition where the arm becomes paralyzed due to an injury to the upper roots of the brachial plexus. The primary root affected is usually C5, although C6 may also be involved in some cases. The main cause of Erb’s palsy is when the arm experiences excessive force during a difficult childbirth, but it can also occur in adults as a result of shoulder trauma.

      Clinically, the affected arm will hang by the side with the elbow extended and the forearm turned inward (known as the waiter’s tip sign). Upon examination, there will be a loss of certain movements:

      – Shoulder abduction (involving the deltoid and supraspinatus muscles)
      – Shoulder external rotation (infraspinatus muscle)
      – Elbow flexion (biceps and brachialis muscles)

      It is important to differentiate Erb’s palsy from Klumpke’s palsy, which affects the lower roots of the brachial plexus (C8 and T1). Klumpke’s palsy presents with a claw hand due to paralysis of the intrinsic hand muscles, along with sensory loss along the ulnar side of the forearm and hand. If T1 is affected, there may also be the presence of Horner’s syndrome.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 24 - A 68 year old female is brought into the emergency department by her...

    Incorrect

    • A 68 year old female is brought into the emergency department by her son due to a two day history of increased confusion and restlessness. The son informs you that the patient had a similar episode 8 months ago that was caused by a urinary tract infection. The son also mentions that the patient is generally in good health but was diagnosed with Parkinson's disease approximately 4 months ago after experiencing a tremor and difficulties with balance. While in the ED, the patient becomes verbally aggressive towards staff and other patients. You decide to administer medication to manage her acute behavior. What is the most suitable choice?

      Your Answer:

      Correct Answer: Lorazepam

      Explanation:

      Haloperidol should not be used in patients with Parkinson’s, Lewy body dementia, or prolonged QT syndrome. It is the first choice for controlling aggressive behavior in most patients with delirium, but lorazepam is preferred for patients with Parkinson’s, Lewy body dementia, prolonged QT syndrome, extrapyramidal side effects, or delirium due to alcohol withdrawal. Haloperidol can reduce the effectiveness of levodopa in Parkinson’s disease by blocking dopamine receptors in the corpus striatum, which can lead to worsened motor function, psychosis, or a combination of both.

      Further Reading:

      Delirium is an acute syndrome that causes disturbances in consciousness, attention, cognition, and perception. It is also known as an acute confusional state. The DSM-IV criteria for diagnosing delirium include recent onset of fluctuating awareness, impairment of memory and attention, and disorganized thinking. Delirium typically develops over hours to days and may be accompanied by behavioral changes, personality changes, and psychotic features. It often occurs in individuals with predisposing factors, such as advanced age or multiple comorbidities, when exposed to new precipitating factors, such as medications or infection. Symptoms of delirium fluctuate throughout the day, with lucid intervals occurring during the day and worse disturbances at night. Falling and loss of appetite are often warning signs of delirium.

      Delirium can be classified into three subtypes based on the person’s symptoms. Hyperactive delirium is characterized by inappropriate behavior, hallucinations, and agitation. Restlessness and wandering are common in this subtype. Hypoactive delirium is characterized by lethargy, reduced concentration, and appetite. The person may appear quiet or withdrawn. Mixed delirium presents with signs and symptoms of both hyperactive and hypoactive subtypes.

      The exact pathophysiology of delirium is not fully understood, but it is believed to involve multiple mechanisms, including cholinergic deficiency, dopaminergic excess, and inflammation. The cause of delirium is usually multifactorial, with predisposing factors and precipitating factors playing a role. Predisposing factors include older age, cognitive impairment, frailty, significant injuries, and iatrogenic events. Precipitating factors include infection, metabolic or electrolyte disturbances, cardiovascular disorders, respiratory disorders, neurological disorders, endocrine disorders, urological disorders, gastrointestinal disorders, severe uncontrolled pain, alcohol intoxication or withdrawal, medication use, and psychosocial factors.

      Delirium is highly prevalent in hospital settings, affecting up to 50% of inpatients aged over 65 and occurring in 30% of people aged over 65 presenting to the emergency department. Complications of delirium include increased risk of death, high in-hospital mortality rates, higher mortality rates following hospital discharge, increased length of stay in hospital, nosocomial infections, increased risk of admission to long-term care or re-admission to hospital, increased incidence of dementia, increased risk of falls and associated injuries and pressure sores.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 25 - A 27 year old male is brought to the emergency department by his...

    Incorrect

    • A 27 year old male is brought to the emergency department by his partner due to increasing drowsiness. The patient's partner informs you that the patient was involved in a physical altercation approximately 40 minutes ago. The patient was struck in the temple and experienced a brief loss of consciousness for around 20 seconds. Initially, the patient appeared to be fine, but after about 20 minutes, he started becoming progressively more drowsy. A CT scan reveals the presence of an extradural hematoma. Which cranial nerve palsy is most commonly observed in this condition?

      Your Answer:

      Correct Answer: Abducens nerve

      Explanation:

      Abducens nerve palsy is often linked to extradural hematoma. When there is a mass effect, downward brain herniation can occur, leading to the involvement of the 6th cranial nerve (abducens nerve, CN VI). This nerve controls the lateral rectus muscle, which is responsible for eye abduction. When the abducens nerve is affected, the lateral rectus muscle is unable to function properly, resulting in an inward turning of the affected eye towards the nose (esotropia).

      Further Reading:

      Extradural haematoma (EDH) is a collection of blood that forms between the inner surface of the skull and the outer layer of the dura, the dura mater. It is typically caused by head trauma and is often associated with a skull fracture, with the pterion being the most common site of injury. The middle meningeal artery is the most common source of bleeding in EDH.

      Clinical features of EDH include a history of head injury with transient loss of consciousness, followed by a lucid interval and gradual loss of consciousness. Other symptoms may include severe headache, sixth cranial nerve palsies, nausea and vomiting, seizures, signs of raised intracranial pressure, and focal neurological deficits.

      Imaging of EDH typically shows a biconvex shape and may cause mass effect with brain herniation. It can be differentiated from subdural haematoma by its appearance on imaging.

      Management of EDH involves prompt referral to neurosurgery for evacuation of the haematoma. In some cases with a small EDH, conservative management may be considered. With prompt evacuation, the prognosis for EDH is generally good.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 26 - A 35-year-old accountant presents with a headache. Since she woke up this morning,...

    Incorrect

    • A 35-year-old accountant presents with a headache. Since she woke up this morning, she describes a right-sided, severe, throbbing headache. She has had similar symptoms previously but feels that this is the worst she has ever had. Her work is very stressful at the moment. She has also vomited this morning. Her husband is with her and is anxious as his mother has recently been diagnosed with a brain tumor. He is really worried that his wife might have the same. On examination, the patient is normotensive with a heart rate of 72 beats per minute, regular. Her cranial nerve examination, including fundoscopy, is normal, as is the examination of her peripheral nervous system. She has no scalp tenderness.
      What is the SINGLE most likely diagnosis?

      Your Answer:

      Correct Answer: Migraine

      Explanation:

      Migraine without aura typically needs to meet the specific criteria set by the International Headache Society. These criteria include experiencing at least five attacks that meet the requirements outlined in criteria 2-4. The duration of these headache attacks should last between 4 to 72 hours. Additionally, the headache should exhibit at least two of the following characteristics: unilateral location, pulsating quality, moderate or severe pain intensity, and aggravation or avoidance of routine physical activity. Furthermore, during the headache, individuals should experience at least one of the following symptoms: nausea and/or vomiting, photophobia, and phonophobia. For more detailed information, you can refer to the guidelines provided by The British Association for the Study of Headache.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 27 - A 35-year-old woman was diagnosed two years ago with multiple sclerosis (MS). She...

    Incorrect

    • A 35-year-old woman was diagnosed two years ago with multiple sclerosis (MS). She has had three relapses in that time, and with each relapse, her symptoms are getting worse. She does have periods of remission, but they don't last long.
      Which SINGLE pattern of MS is she experiencing?

      Your Answer:

      Correct Answer: Primary progressive MS

      Explanation:

      Multiple sclerosis (MS) is a condition characterized by the demyelination of nerve cells in the brain and spinal cord. It is an autoimmune disease caused by recurring inflammation, primarily affecting individuals in early adulthood. The ratio of affected females to males is 3:2.

      There are several risk factors associated with MS, including being of Caucasian race, living at a greater distance from the equator (as the risk increases), having a family history of the disease (with approximately 20% of MS patients having an affected relative), and smoking. Interestingly, the rates of relapse tend to decrease during pregnancy.

      MS can present in three main patterns. The most common is relapsing and remitting MS, characterized by periods of no symptoms followed by relapses (present in 80% of patients at diagnosis). Primary progressive MS is less common, with symptoms developing and worsening from the beginning and few remissions (present in 10-15% of patients at diagnosis). Secondary progressive MS follows relapsing/remitting MS, with worsening symptoms and fewer remissions (approximately 50% of those with relapsing/remitting MS will develop this within 10 years of diagnosis). Progressive relapsing MS is rare and involves a steady decline in neurological function from the onset of the disease, with superimposed attacks also occurring.

      Certain factors can indicate a more favorable prognosis for individuals with MS. These include having a relapsing/remitting course, being female, experiencing sensory symptoms, and having an early age at onset.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 28 - A 45-year-old patient has sustained an injury to their left upper limb, resulting...

    Incorrect

    • A 45-year-old patient has sustained an injury to their left upper limb, resulting in a peripheral neuropathy. Upon examination, the patient presents with clawing of their hand, with hyperextension of the metacarpophalangeal joints and flexion of the distal and proximal interphalangeal joints of the little and ring fingers. However, their wrist flexion remains normal. Sensory loss is observed over the palmar surface of the medial one and a half fingers, while sensation in the rest of the hand and forearm, including the palm and dorsal aspect of all fingers, is normal. Additionally, Froment's sign is positive.

      Which specific nerve has been affected in this case?

      Your Answer:

      Correct Answer: Ulnar nerve at the wrist

      Explanation:

      The ulnar nerve originates from the medial cord of the brachial plexus, specifically from the C8-T1 nerve roots. It may also carry fibers from C7 on occasion. This nerve has both motor and sensory functions.

      In terms of motor function, the ulnar nerve innervates the muscles of the hand, excluding the thenar muscles and the lateral two lumbricals (which are supplied by the median nerve). It also innervates two muscles in the anterior forearm: the flexor carpi ulnaris and the medial half of the flexor digitorum profundus.

      Regarding sensory function, the ulnar nerve provides innervation to the anterior and posterior surfaces of the medial one and a half fingers, as well as the associated palm and dorsal hand area. There are three sensory branches responsible for the cutaneous innervation of the ulnar nerve. Two of these branches arise in the forearm and travel into the hand: the palmar cutaneous branch, which innervates the skin of the medial half of the palm, and the dorsal cutaneous branch, which innervates the dorsal skin of the medial one and a half fingers and the associated dorsal hand. The third branch arises in the hand and is called the superficial branch, which innervates the palmar surface of the medial one and a half fingers.

      When the ulnar nerve is damaged at the elbow, the flexor carpi ulnaris and the medial half of the flexor digitorum profundus muscles in the anterior forearm will be spared. However, if the ulnar nerve is injured at the wrist, these muscles will be affected. Additionally, when the ulnar nerve is damaged at the elbow, flexion of the wrist can still occur due to the intact median nerve, but it will be accompanied by abduction as the flexor carpi ulnaris adducts the hand. On the other hand, wrist flexion will be unaffected when the ulnar nerve is damaged at the wrist.

      The sensory function also differs depending on the site of damage. When the ulnar nerve is damaged at the elbow, all three cutaneous branches will be affected, resulting in complete sensory loss in the areas innervated by the ulnar nerve. However, if the damage occurs at the wrist, the two branches that arise in the forearm may be spared.

      Damage to the ulnar nerve at either the elbow or wrist leads to a characteristic claw hand appearance.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 29 - A 6-year-old boy comes in with a headache, stiffness in his neck, and...

    Incorrect

    • A 6-year-old boy comes in with a headache, stiffness in his neck, and sensitivity to light. He has a known allergy to penicillin and had to spend some time in the ICU because of it. He has also recently developed a rash of small red or purple spots on his arms and legs.

      What is the MOST suitable next course of action in managing his condition?

      Your Answer:

      Correct Answer: Chloramphenicol

      Explanation:

      This girl is displaying symptoms and signs that are consistent with a diagnosis of meningococcal septicaemia. It is crucial that she receives urgent antibiotic treatment. If a patient has a penicillin allergy, but not anaphylaxis, a third-generation cephalosporin like cefotaxime may be administered. However, in this particular case, the girl has a documented history of anaphylaxis to penicillin. It is important to note that up to 10% of patients who are allergic to penicillin may experience an adverse reaction to cephalosporins. In situations where there is a true anaphylactic reaction to penicillins, the British National Formulary (BNF) recommends the use of chloramphenicol as an alternative treatment option.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 30 - A child arrives at the Emergency Department with a petechial rash, headache, neck...

    Incorrect

    • A child arrives at the Emergency Department with a petechial rash, headache, neck stiffness, and sensitivity to light. You suspect a diagnosis of meningococcal meningitis. The child has a previous history of experiencing anaphylaxis in response to cephalosporin antibiotics.
      Which antibiotic would you administer to this child?

      Your Answer:

      Correct Answer: Chloramphenicol

      Explanation:

      Due to the potentially life-threatening nature of the disease, it is crucial to initiate treatment without waiting for laboratory confirmation. Immediate administration of antibiotics is necessary.

      In a hospital setting, the preferred agents for treatment are IV ceftriaxone (2 g for adults; 80 mg/kg for children) or IV cefotaxime (2 g for adults; 80 mg/kg for children). In the prehospital setting, IM benzylpenicillin can be given as an alternative. If there is a history of anaphylaxis to cephalosporins, chloramphenicol is a suitable alternative.

      It is important to prioritize prompt treatment due to the severity of the disease. The recommended antibiotics should be administered as soon as possible to ensure the best possible outcome for the patient.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Neurology (2/7) 29%
Passmed