Neuro Revision Session Flashcards
(25 cards)
A 30-year-old woman had a sudden onset headache while having sexual intercourse 1 hour ago. She describes it as the worst headache of her life. She is GCS 15 with neck stiffness and photophobia. Her CT brain is normal.
What is the single next most appropriate course of action?
A .Give analgesia, discharge and advise to return if symptoms worsen
B. Perform cerebral angiography (digital subtraction angiogram)
C. Perform lumbar puncture 6–12 hours after onset of symptoms
D.Prescribe immediate IV antibiotics E Repeat CT brain in 2 hours and discharge if normal
**C. Perform lumbar puncture 6–12 hours after onset of symptoms **
A 21-year-old man has a subarachnoid haemorrhage. His GCS score is 13 (E3 V4 M6) with weakness in his left arm. A CT angiogram confirms the presence of a middle cerebral artery aneurysm with normal-sized ventricles and no haemorrhage within them. He suddenly becomes comatose (GCS 3, E1 V1 M1) with a fixed dilated right pupil.
What is the single most likely cause of his symptoms?
A. Hydrocephalus
B.Hyponatraemia
C. Repeat rupture of aneurysm with repeat haemorrhage
D. Seizures
E. Vasospasm and delayed ischaemic neurologic deficit
C. Repeat rupture of aneurysm with repeat haemorrhage
- re-rupture is biggest risk post SAH
- CN III palsy
How long after SAH does hydrocephalus occur? [1]
5-7 days
How long after SAH does vasospasm and dealyed ischaemia neurological deficit? [1]
~ week later
- Add nimodopine
A 50-year-old man has sudden onset headache, vomiting and impaired eye movements. Over the past 6 months he has noticed a progressive decline in his peripheral vision and his shoes, hat and wedding ring have become too small for him. An MRI confirms he has a brain tumour.
What is the single most likely location of his lesion?
A .Brainstem
B. Cerebellum
C. Frontal lobe
D. Pituitary gland
E. Thalamus
What is first line treatment?
D. Pituitary gland
- acromegaly
- treat with trans-sphenoidal surgery first
A 68-year-old woman has worsening back pain and weakness in both legs that has worsened over the past 3 days. She has difficulty walking but her bowel and bladder function is normal. She has a past history of breast cancer.
Which is the single most appropriate next step?
A. CT spine
B. Dexamethasone infusion
C. MRI of the lumbar spine
D. MRI of the whole spine
E.Refer to oncology and neurosurgery departments
A 68-year-old woman has worsening back pain and weakness in both legs that has worsened over the past 3 days. She has difficulty walking but her bowel and bladder function is normal. She has a past history of breast cancer.
Which is the single most appropriate next step?
A. CT spine
B. Dexamethasone infusion
C. MRI of the lumbar spine
D. MRI of the whole spine
E.Refer to oncology and neurosurgery departments
A 21-year-old man has sudden onset back and leg pain. He was lifting weights in the gym when he developed acute pain radiating down his right leg. He has difficulty passing urine and cannot feel the toilet paper while using the bathroom.
What is the single most appropriate next step?
A. Analgesia and discharge with MRI scan in 6 weeks
B. Analgesia and discharge with outpatient referral to neurosurgery
C. CT spine
D. Dexamethasone infusion
E.MRI spine
E.MRI spine
What is important to note about timing of CES sx with regards to treatment? [1]
If sensory sx are present then unlikely to improve. Surgery is used to prevent further damage as opposed to relieving
A 40-year-old man has developed unilateral retro-orbital stabbing pain. He has ipsilateral eye watering, nasal stuffinessand ptosis. The pain is very severe and he is restless and pacing around the ward.
What is the single best initial treatment plan?
A. High-flow oxygen and oral triptan
B. High-flow oxygen and subcutaneous triptan
C. Paracetamol and NSAID
D. Paracetamol, NSAID and antiemetic
E. Paracetamol, NSAID and morphine
B. High-flow oxygen and subcutaneous triptan
A 40-year-old woman has neck pain and burning pain in her right arm radiating to her middle finger. She has weakness in elbow extension and absent triceps reflex. MRI spine demonstrates a cervical disc prolapse.
What is the single most likely combination of nerve root and disc to be affected?
A.C4 nerve root with C3–4 disc prolapse
B. C6 nerve root with C4–5 disc prolapse
C. C6 nerve root with C5–6 disc prolapse
D. C7 nerve root with C6–7 disc prolapse
E. C7 nerve root with C7–T1 disc prolapse
A 40-year-old woman has neck pain and burning pain in her right arm radiating to her middle finger. She has weakness in elbow extension and absent triceps reflex. MRI spine demonstrates a cervical disc prolapse.
What is the single most likely combination of nerve root and disc to be affected?
D. C7 nerve root with C6–7 disc prolapse
- tricep reflex
A 51-year-old man has lower lumbar back pain and fever. He had an operation 1 week ago to remove an intervertebral disc prolapse causing nerve root compression. He has no neurological deficit. An MRI scan confirms vertebral osteomyelitis following surgery.
What is the single most likely causative organism?
A. Aspergillus
B. Escherichia coli
C.Salmonella
D. Staphylococcus aureus
E. Mycobacterium tuberculosis
D. Staphylococcus aureus
A 51-year-old man has lower lumbar back pain and fever. He had an operation 1 week ago to remove an intervertebral disc prolapse causing nerve root compression. He has no neurological deficit. An MRI scan confirms vertebral osteomyelitis following surgery.
How would you treat this? [3]
Remove metal work
Wound wash out; send samples to microbiologist
Start Abx ASAP - flucoxacillin
A 78-year-old man has neck pain following a fall. On examination he has weakness in both hands with loss of reflexes. Pain and temperature sensation is reduced in both arms. He has increased tone in his legs with hyperreflexia and a positive Babinski sign. MRI demonstrates a C6 segmental cervical cord injury.
What is the single most likely diagnosis?
A.Anterior cord syndrome
B. Brown-Séquard syndrome
C. Cauda equina syndrome
D. Central cord syndrome
E/ Posterior cord syndrome
A.Anterior cord syndrome
- complete loss of pain, temp and movement
D. Central cord syndrome
What type of mechanism of injury would cause central cord syndrome? [1]
Hyperextension
How does central cord syndrome present? [1]
Upper > lower motor
A 58-year-old woman has a fever and meningism. She has no focal neurological deficits. Meningitis is suspected and a lumbar puncture is performed which reveals a high white cell count (mainly polymorphs), low glucose in comparison to serum and turbidity. Gram-negative bacilli are seen.
What is the single most likely causative pathogen?
A.Haemophilus influenzae
B. Herpes simplex virus
C. Neisseria meningitidis
D. Staphylococcus aureus
E.Streptococcus pneumoniae
A.Haemophilus influenzae: gram -ve bacilli
C. Neisseria meningitidis
- Gram -ve diplococci
D. Staphylococcus aureus
- Gram +ve
E.Streptococcus pneumoniae
- Gram +ve
A 21-year-old man is a university student who has recently been unwell with flu-like symptoms. Since yesterday he has had nausea and vomiting, aversion to light and neck stiffness. He has a rash that is non blanching on his arms and legs.
What is the single most appropriate next action?
A. Immediate broad-spectrum IM/IV antibiotics
B. Perform lumbar puncture
C. Prescribe oral antibiotics and discharge
D. Transfer immediately to emergency department
E. Urgent CT brain scan
A. Immediate broad-spectrum IM/IV antibiotics
A 30-year-old man has had 6 months of proximal leg weakness, 3 months of bilateral hand intention tremor and now tongue fasciculations. He has no leg reflexes, flaccid weakness in his leg which is worse proximally, and some past-pointing with both hands. He has no upper motor neurone signs.
What is the single most likely diagnosis?
A.Friedreich’s ataxia
B.Limb onset motor neurone disease
C.Multiple sclerosis
D. Spinal muscular atrophy
E. Spinocerebellar ataxia
B.Limb onset motor neurone disease
- tongue fasiculations: think MND
A 26-year-old woman is out shopping with her family when they notice her left arm and leg shaking. This continues for 2 minutes after which it stops spontaneously. She has no recollection of the event.
Which is the single best description of her seizure type?
A.Complex partial
B. Complex partial with secondary generalisation
C.Generalised
D. Simple partial
E. Status epilepticus
A.Complex partial
- One side of the body
- Complex bc can’t remember
What is the difference between simple and complex seizures? [1]
What is the difference between partial and generalised seizures? [1]
Partial (also called focal) seizures begin in one area of the brain = one side of the body
Generalized seizures involve both sides of the brain = both sides of body impacted
Partial seizures can be further classified as simple partial (where awareness is retained) or complex partial (where awareness is altered)
A 29-year-old woman has been in seizure persistently for 10 minutes without regaining consciousness. She has no history of seizures. She is resuscitated and placed in the recovery position. No drugs have been administered. The seizures continue.
What is the single most appropriate next step?
A. Give carbamazepine
B. Give IV lorazepam
C. Start magnesium sulphate infusion
D. Start phenytoin infusion
E. Transfer to the intensive care unit for intubation and ventilation.
B. Give IV lorazepam
A 50-year-old woman has a history of bilateral progressive tremor and recent falls. She has difficulty swallowing and is very tearful. On examination she has severe stiffness in her neck and trunk. She has difficulty moving her eyes in a vertical direction.
What is the single most likely diagnosis?
A .Dementia with Lewy bodies
B. Idiopathic Parkinson’s disease
C. Multiple systems atrophy
D. Progressive supranuclear palsy
E. Pseudobulbar palsy
D. Progressive supranuclear palsy
E. Pseudobulbar palsy
- difficulty with deglutition and mastication, increase of tongue reflexes and spasticity not only of the tongue but also the musculature of the pharynx and larynx.
A 46-year-old man has a past medical history of alcohol use. He is unkempt and looks emaciated. On examination he is confused, has an ataxic gait and complains of diplopia especially on lateral gaze.
What is the single most likely diagnosis?
A. Cobalamin deficiency
B. Nicotinic acid deficiency
C. Pyridoxine deficiency
D. Riboflavin deficiency
E. Thiamine deficiency
E. Thiamine deficiency
How would nicotinic acid deficiency present?
The classic triad is known as the “three Ds”: dermatitis, dementia, and diarrhea
