Neuro

Question 1

A 39-year old man presents to the emergency department with a rapid onset of facial weakness. He complains of a dry mouth and intolerance to loud noises. On examination, he has evidence of left-sided facial weakness, including the forehead.

Answer 1

Bell’s palsy

Question 2

A 72-year-old female presents following a fall. She has back pain, leg numbness, and urinary retention. On examination, she has weakness and absent pinprick sensation of both legs, with poor anal sphincter tone.

Answer 2

Cauda Equina Syndrome

Question 3

A 32-year-old male presents with recurrent severe headaches and excruciating pain around his left eye. His left eyelid swells and produces tears. He is a frequent drinker and smoker.

Answer 3

Cluster headache

Question 4

A 32-year-old man is involved in a high-speed car crash and is taken to the Emergency Department. He complains of numbness ‘down-below’ and cannot move his legs. On examination, there is no sensation from the umbilicus downward. MRI spine reveals a traumatic cord injury.

Answer 4

Spinal cord compression

Question 5

A 32-year-old male is brought to the emergency department. He is clutching his head and shouting. His wife reports that she found him shaking vigorously. His temperature is 40°C.

Answer 5

Encephalitis
- main cause is herpes simplex virus (HSV)

Question 6

A 36-year-old male with a background of HIV presents with confusion and fever. He is disorientated and states repeatedly that he is ‘dying from a headache’.

Answer 6

Encephalitis

Question 7

A 22-year old man presents with two seizures within the last month. A witness describes his seizures as his limbs becoming stiff and his whole body jerking for 2-3 minutes. During the seizure he is unconscious, and he is confused for 30 minutes after.

Answer 7

Generalised Tonic-Clonic seizures

Question 8

A 30-year-old known epileptic is brought to the emergency department by ambulance with an ongoing tonic-clonic seizure for the last 7 minutes.

Answer 8

Status Epilepticus

Question 9

A 23-year-old man attends the Emergency Department after having a blackout episode earlier that day. He is currently a medical student at the local hospital and felt unwell whilst in theatre. He starting sweating and feeling nauseated before falling to the floor.

Answer 9

Vasovagal Syncope (faint)

Question 10

An 83-year-old woman is brought to the GP by her daughter who has noticed a change over the past 6 months. She reports her mum is frequently misplacing the house keys and repeatedly asking the same questions. A few days ago, her mum was found wandering in the street by her neighbours, confused as to which house was hers.

Answer 10

Dementia

Question 11

A 69-year-old man presents with a 1-year history of mild slowness and loss of dexterity. His handwriting has become smaller, and his wife feels his face is less expressive and his voice softer. Over the last few months he has developed a subtle tremor in the right hand, noted while watching television. His symptoms developed insidiously but have mildly progressed. He has no other medical history, but he has noted some mild depression and constipation over the last 2 years.

Answer 11

Parkinson’s

Question 12

A 62-year-old woman presents with a bilateral hand tremor which she believes has been getting worse for the last 10 years. It is not present at rest but limits performing certain tasks such as drinking a cup of tea or writing. Her father had a similar problem.

Answer 12

Benign essential tremor

Question 13

A 49-year-old female presents to her GP with sharp facial pain. The pain only occurs on the right-hand side and always at night when she is brushing her teeth.

Answer 13

Trigeminal neuralgia

Question 14

A 30-year old male presents to the emergency department with weakness which started in his legs but is now affecting his arms and hands. This is also associated with numbness and tingling. He had a 5-day episode of diarrhoea around 4 weeks ago.

Answer 14

Guillain-Barre syndrome

Question 15

A 6-year-old girl presents with her family, who have immigrated to the UK. She vomits and complains of the “bright lights”. She is pale, sweaty, hot to touch and has a non-blanching rash.

Answer 15

Meningitis

Question 16

A 42-year-old school teacher presents with difficulty managing her classroom. She has become increasingly irritable with students and fails to complete assigned tasks on time. Her sister and husband report that she has become restless, pays less attention to her appearance and social obligations, and at times is anxious and upset. On examination while seated with her eyes closed, brings out random ‘piano-playing’ movements of the digits along with other movements of the limbs, torso, and face.

Answer 16

Huntington’s Disease

Question 17

A 59-year-old male presents with increasing clumsiness when he walks. Recently, he has tripped over twice and is unable to go jogging due to leg weakness. On examination, he has tongue fasciculations and bilateral lower limb weakness.

Answer 17

Motor neurone disease

Question 18

A 39-year-old female teacher presents with a burning sensation affecting her arms and legs. She thinks she is becoming colour blind, as she can no longer discern the colour of the red pen she uses for marking.

Answer 18

Multiple sclerosis

Question 19

A 29-year-old female presents with double vision and weakness in her arms that is most noticeable in the evening. This is starting to affect her ability to work as a climbing instructor.

Answer 19

Myasthenia gravis

Question 20

A 65-year old man presents to his GP with concerns about a ‘shake’ that he has noticed in his right hand. This hand is stiffer than his left and he now struggles to do up buttons. He also feels that his walking is slower and he is less steady than before.

Answer 20

Parkinsons disease

Question 21

An 18-year-old female student is brought to the emergency department by her parents with a 12-hour history of headache and vomiting. The headache came on gradually and is 6/10 in severity. It is not relieved by paracetamol.

On examination, she is unable to tolerate fundoscopy. On passive flexion of her neck, there is involuntary flexion of her hips. Otherwise, there is no motor or sensory loss.

Answer 21

Meningitis

Question 22

A 23-year-old female presents to her GP with low mood which has affected her almost every day for the past month. She has lost interest in painting and feels less energetic, whilst also finding it difficult to sleep at night

Answer 22

Depression

Question 23

You see a 25 year old lady in clinic who is complaining of a recurring headache. She tells you that the pain is
unilateral and is worse on movement. She gets some nausea with the headaches and sometimes also gets
scotomas before they happen

Answer 23

Migraine

Question 24

A 40-year-old female presents to A+E with a severe unilateral right sided headache that is present around
her orbital region. She describes a boring pain that started an hour ago and it is excruciating, she also
mentions that she has vomited twice since it started. From inspection you notice that her right eye is blood
shot and there is a slight ptosis.

Answer 24

Cluster headache

Question 25

A 60-year-old male patient comes into A&E with acute onset unilateral facial drooping. He takes amlodipine
for hypertension, and has recently had a viral infection. Within 24 hours, the facial drooping has resolved, and the patient has no other symptoms. What is your
diagnosis?

Answer 25

Transient ischaemic attack

Question 26

A 62-year-old male patient comes into A&E complaining of severe lower back pain that radiates down to his
buttocks. He is reluctant to tell you that he has been incontinent of urine in the last hour, and has no sensation in his area of genitalia. He has a past medical history of metastatic prostate cancer. PR
examination shows a lack of anal tone

Answer 26

Cauda equina syndrome

Question 27

A 23-year-old man comes into A&E from a car accident, with a brief loss of consciousness but improved
temporarily, but is deteriorating again. He has a headache, his pupil is dilated, his breathing has become
deep and irregular and he is confused

Answer 27

Extradural haemorrhage