Neurology

Question 1

patient with a stroke AND ecg showing they have atrial fibrilliation

already on aspirin and simvastatin since stroke.

most appropriate long term plan for secondary stroke prevention?

Answer 1

Apixaban!!! (an xa-inhbitor)

or warfarin

as anticoagulation

in acute management of stroke, 300mg of aspirin only given after ct is done to rule out hemorrhagic stroke

Question 2

A 79 year old man has difficulty breathing. He had a carotid endarterectomy 2
hours ago. His pulse is 120 bpm, BP 92/52 mmHg and oxygen
saturation 97% breathing high-flow oxygen by mask. His neck is swollen and
he appears anxious and distressed, with loud stridor.

most likely explanation for detrioration?

Answer 2

hemorrhage compressing the airway!!

-> complication of carotid endarterectomy

Question 3

2. A 65 year old woman has a week of disorientation and dizziness. She also has headaches that are worse when bending over and associated with vomiting. She had a non-small cell lung cancer that was treated with radical radiotherapy two years ago.BP is 178/95 mmHg. She has no focal Neurological signs. What is the diagnosis? UKMLA question.

Answer 3

Cerebral Mets!,

Typical Observations due to intracanial hypertension secondary to cerebral metastases

Question 4

woman has severe neck chest and back pain after a fall

cxr clear with left sided rib fracture
CT head is clear except orbital fracture

most appropriate next investigation?

Answer 4

CT scan of neck!!!!

history and exam suggests cervical spine fracture

Question 5

when would a CT scan of head be indicated after a fall?

Answer 5

LOC
OR amnesia

Question 6

sudden severe headache 4 hours ago. autosomal dominant polycystic kidney disease

neuro exam and CT scan head normal

next step in management?

Answer 6

lumbar puncture!!!

patient most likely had a subarrachnoid hemorrhage

negative CT scan must be followed up with lumbar puncture

Question 7

Question describing A focal Siezure affecting patients right hemisphere as a result of a previous stroke

Question 8

spinal stenosis presentation?

Answer 8

neurogenic claudication - eg numbeness and weakness of legs that come on with walking that improve with leaning forward

Question 9

A 17 year old boy has repeated episodes characterised by a funny ‘racing’
sensation in his abdomen, followed by loss of awareness. His girlfriend
describes that he has a vacant stare and waves his left arm around in a
writhing manner during these attacks.

what is the most likely site origin of these episodes?

Answer 9

right temporal lobe

He has focal onset impaired awareness
seizures, the aura implicates one of the temporal lobes. In the seizure
itself he waves his left arm, suggesting spread to the right frontal lobe (though
the origin is elsewhere).

Question 10

A 46 year old woman attends the Emergency Department with fever,
headache and confusion, which developed over several hours. She finds it
impossible to lift her head from the pillow and resists the doctor’s attempts to
feel her neck.
Her temperature is 38.1°C, pulse rate 105 bpm and BP 110/60
mmHg. Her GCS score is 14.
A CT scan of her head is normal. A lumbar puncture is performed

Answer 10

High pressure, raised protein, excess neutrophils

Question 11

TIA management?

management if patient on anticoagulants or has bleeding disorder?

Answer 11

300mg aspirin + specialist review within 24hrs

anticoagulants = immediate non contrast! CT to rule out hemorrhage

TIA may present as amurosis fugax

All TIA patients should have an urgent carotid doppler?

Question 12

bells palsy management?

Answer 12

oral prednisolone and artificial tears

aciclovir is not given!!

if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT

Question 13

baclofen not helping enough for patient with muscle stiffness in with MS. other first line option?

acute relapse treatment?

Answer 13

gabapentin

oral or IV methylprednisolone

Question 14

MS baseline investigation?

Answer 14

MRI WITH contrast

Question 15

other bells palsy symptoms?

Answer 15

post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis

Question 16

plasmodium vivax, treated with chloroquine, what other drug needed?

Answer 16

non falcipaurm palsmodium thus primaquine!! also neededd to treat the stores of parasite

Question 17

loss of foot dorsiflexion/foot drop + sensory loss dorsum of the foot

Answer 17

L5 lesion!!! - can also cause weakness of hip abduction

L3 = Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

L4 =Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test

L5 = Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test

S1 = Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test

*note, no L2. just 3,4,5 + S1

Question 18

Suspected TIA, normal management is what?

when would you admit to hospital urgently instead for urgent imaging and what type of imaging?

in a TIA clinic, most appropriate next step in management?

Answer 18

normal management = 300mg aspirin + urgent specialist assessment within 24 hours to include imaging choice usually mri w diffusion weighted imaging vs stroke which is ALWAYS non contrast CT

If a patient presents more than 7 days ago they should be seen by a stroke specialist clinician as soon as possible within 7 days + aspirin

hospital admission =
on warfarin doac or has bleeding disorder = urgent admission = CT head!!! as there is a concern about hemorrhage -> contrast MRI which is preferred imaging

Question 19

A combination of thrombolysis AND thrombectomy is recommend for patients with an acute ischaemic stroke who present within 4.5 hours

Question 20

at what age is amoxicillin added on to IV cefotaxime/ceftriaxone for meningitis?

Answer 20

> 50

Question 21

what further investigations done if symptoms of subarachnoid headache, and CT done more than 6 hours from symptom onset and it is negative?

what would be finding of this further investigation?

Answer 21

if CT head is done more than 6 hours after symptom onset and is normal
do a lumber puncture (LP)!!!!

timing wise the LP should be performed at least 12 hours!!! following the onset of symptoms to allow the development of xanthochromia!!!(the result of red blood cell breakdown- bilirubin in CSF).

xanthochromia helps to distinguish true SAH from a ‘traumatic tap’ (blood introduced by the LP procedure).

as well as xanthochromia, CSF findings consistent with subarachnoid haemorrhage include a normal or raised opening pressure

Question 22

Describe the type of siezures that occur in each lobe of the brain

Answer 22

Temporal lobe - automatisms (e.g. lip smacking/grabbing/plucking) are common

An aura occurs in most patients
typically a rising epigastric sensation
also psychic or experiential phenomena, such as dejà vu, jamais vu
less commonly hallucinations (auditory/gustatory/olfactory)

Frontal lobe (motor) Head/leg movements, posturing, post-ictal weakness, Jacksonian march (clonic movements travelling proximally)

Parietal lobe (sensory) Paraesthesia

Occipital lobe (visual) Floaters/flashes

Question 23

First line treatment in diabetic neuropathy is with?

Answer 23

amitriptyline, duloxetine, gabapentin or pregabalin

Question 24

when should a lumbar puncture be delayed in suspected bacterial meningitis?

Answer 24

signs of severe sepsis or a rapidly evolving rash!!!!
severe respiratory/cardiac compromise
significant bleeding risk

signs of raised intracranial pressure:
focal neurological signs
papilloedema
continuous or uncontrolled seizures
GCS ≤ 12

Question 25

most suitable contraceptivea for a woman with epilepsy on carbamezapine?

Answer 25

copper IUD mirena coil - preferred if heavy bleeding or progesterone injection - weight gain so avoid if obese, and less preferred due to effect on bone density

Question 26

brain abscess treatment?

Answer 26

ceftriaxone and metronidazole

Question 27

migraine PROPHYLAXIS treatment?

Answer 27

propanolol! - avoid in asthma topiramate! - but avoid in women of childbearing age¬!

Question 28

A 23-year-old man is brought to the emergency department after a generalised tonic-clonic seizure. Over the past 4 days, he has had a fever, headaches, drowsiness, and irritability. He is known to have HIV, but his viral load and adherence to antiretroviral therapy are not known. His pulse is 85 beats per minute, blood pressure is 134/74 mmHg, and oxygen saturation is 97% on room air. He has nuchal rigidity but no rashes are noted. A CT scan of the head shows ill-defined hypodense areas in the bilateral temporal lobes and inferior frontal lobes.

Answer 28

herpes simplex encephalitis!! ill defined nad not ring enhanced so not toxoplasmosis not cryptococcal meningitis - would show meningeal enhancement and signs of cerebral edema

Question 29

which motor neuron disease has worst prognosis?

Answer 29

progressive bulbar palsy

Question 30

name a medication that can trigger migraines

Answer 30

ocp

Question 31

A 62-year-old man presents to the emergency department after a fall. He has not lost consciousness, did not hit his head, and was brought in via ambulance after 3 hours as he could not stand up after falling. Over the last few months, he has felt weak. His only history is gastroenteritis 8 months ago. He has bilateral leg muscle atrophy and reduced power in both the upper and lower limbs, which are worse on the left. Sensation and coordination are intact. The biceps and triceps reflexes are absent, however, the ankle and knee reflexes are brisk. Babinski's sign is positive. What is the most likely diagnosis?

Answer 31

ALS !! = Asymmetrical limb weakness, mix of upper and lmn signs Primary lateral sclerosis = no LMN signs so no fasiculations, weak reflexes or atrophy. only UMN

Question 32

Acute sinusitis complication, fever headache, nausea (raised icp) difficulty raising right arm and leg(focal neurology - can also present with oculomotor or abducens nerve palsy) ? differentials?

Answer 32

brain abscess - can also occur with ear infections cavernous sinus thrombosis = unilateral facial oedema, photophobia, proptosis and palsies of the cranial nerves which pass through it (III, IV, V, VI).

Question 33

women with painful eye movements and visual disturbance, urinary incontinence and frequency. imaging modality required

Answer 33

MRI WITH contrast. most likely MS -optic neuritis

Question 34

common stroke territories

Question 35

essential tremor features? management?

Answer 35

postural tremor: worse if arms outstretched improved by alcohol and rest Propanolol

Question 36

Investigation for vestibular shwannoma?

Answer 36

MRI of the cerebellopontine angle - CN V, VII, VIII

Question 37

A woman of childbearing age who presents with generalised tonic-clonic seizures should be offered what seizure medication?

Answer 37

Lamotrigine or levetiracetam Even if on the contraceptive pill!

Question 38

In a patient with dizziness and right sided hearing loss, what test would point to a shwannoma?

Answer 38

Absent corneal reflex!

Question 39

Elbow injury with wrist drop, most likely anatomical site of injury?

Answer 39

Fracture of the shaft of humerus!, = damage to radial nerve Supracondylar fracture of humerus is most commonly associated with ulnar nerve damage. Fracture of the proximal humerus is most commonly associated with axillary nerve damage.

Question 40

Differentiate focal impaired awareness seizures from generalized absence seizures

Answer 40

Generalised absence seizure is wrong. Although during these seizures awareness is also lost, they usually only last a few seconds and the patient may also transiently lose their consciousness without realising it. In addition, they are mostly seen in young children with no associated signs and automatism Focal impaired awareness = automatisms + stare focal aware siezures = may have olfactory hallucinations eg youre smelling roses so sign patient is conscious

Question 41

A 17-year-old man is referred to neurology after experiencing several strange episodes during which his parents report him smacking his lips and plucking at his clothes. He does not experience any other symptoms. most appropriate drug to manage?

Answer 41

this is a focal siezure as it is occuring in the temporal lobe management for focal siezure = lamotrigine or levitiracetam first line Generalised tonic-clonic seizures males: sodium valproate females: lamotrigine or levetiracetam Focal seizures first line: lamotrigine or levetiracetam! Absence seizures (Petit mal) first line: ethosuximide Myoclonic seizures males: sodium valproate females: levetiracetam Tonic or atonic seizures males: sodium valproate females: lamotrigine

Question 42

You want to prescribe an antiemetic to a 19-year-old female who is having a migraine attack. Which one of the following medications is most likely to precipitate extrapyramidal side-effects?

Answer 42

metoclopramide

Question 43

A 40 years old patient presents to GP with weakness of her right hand, sensory loss to her little finger and wasting of hypothenar compartment. On examination, you have noticed that the thumb adduction is weak. You recall from your anatomy lecture that adductor pollicis is responsible for the thumb adduction. Where is the most likely site of the lesion?

Answer 43

ulnar nerve Motor to medial two lumbricals aDductor pollicis interossei hypothenar muscles: abductor digiti minimi, flexor digiti minimi flexor carpi ulnaris Sensory to medial 1 1/2 fingers (palmar and dorsal aspects)

Question 44

complains of pain in his shoulder and struggles to hold cutlery to eat dinner. He cannot adduct his thumb or abduct his fingers and the medial aspect of his elbow feels numb. Which of the following nerve roots is most likely to be affected?

Answer 44

T1 !!! -> ulnar nerve. Klumpe palsy described Erb-Duchenne paralysis = damage to C5,6 roots winged scapula

Question 45

what is the meningitis prophylaxis in contacts?

Answer 45

Oral ciprofloxacin single dose!!! - avoid if history of achilles tendon rupture or rifampicin

Question 46

moto neuron disease is associated with which type of dementia?

Answer 46

fronto temporal dementia

Question 47

multiple sclerosis 3 months ago by the neurology department. This paresthesia has persisted for 2 days and is accompanied by worsening fatigue and urinary frequency/urgency symptoms. A urine dip is unremarkable. What would be the most appropriate treatment to start in these circumstances?

Answer 47

Iv or oral methylprednisolone!!! high dose - this is an acute relapse meanwhile drugs eg beta inteferon, natalizumab are used as prophylaxis to prevent relapse

Question 48

If subarachnoid haemorrhage is suspected but a CT head done within 6 hours of symptom onset is normal, do not do an LP, consider an alternative diagnosis instead. CT after 6 hours is not definitive thus need to do LP within 4!! hours

Question 49

45-minute episode of right-sided upper limb weakness that occurred the previous day and has fully resolved. An MRI conducted today confirmed the diagnosis of a transient ischaemic attack (TIA). His blood pressure is currently 132/81 mmHg. Carotid Doppler ultrasound reveals a 72% stenosis in the left carotid artery and a 76% stenosis in the right carotid artery. He has no other relevant medical history. What is the most appropriate next step in managing this patient?

Answer 49

urgent left sided carotid endarterectomy!!! side contralateral to symptoms!! Not the more occluded vessel

Question 50

most common cause of viral meningitis?

Answer 50

enteroviruses - eg cocksackie

Question 51

There is a small left para-central L4/5 disc prolapse causing compression of the transiting L5 nerve root. There is no compression of the cauda equina management?

Answer 51

Start treatment with NSAIDs and refer for physiotherapy patient has sciatica!! A prolapsed lumbar disc usually produces clear dermatomal leg pain associated with neurological deficits. If the pain has failed to settle after 4-6 weeks of physiotherapy and anti-neuropathic agent treatment then it would be sensible to consider referring routinely to spinal surgery.

Question 52

chronic fatigue syndrome must be present for how long to make a diagnosis?

Answer 52

3 months!

Question 53

A 64-year-old male presents to his GP practice with a few-month history of weakness. He reports that he first noticed having difficulty opening jars, which has now progressed to difficulty getting dressed. He has also noticed that he is tripping up around the house. His wife who has attended with him says that she feels his speech has become slurred on occasion. On examination of the upper limbs you find: Fasciculations Wasting of small muscles of the hands bilaterally Increased tone bilaterally Power 3/5 in most limb movements Brisk reflexes Sensation normal Given the most likely diagnosis, which of the following muscles are typically spared?

Answer 53

ocular muscles - eye movements spared patient has motor neuron disease

Question 54

name some drugs that can worsen myaesthenia gravis! and cause atrial fibrillation

Answer 54

beta blockers`!!!! penicillamine quinidine, procainamide lithium phenytoin antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Question 55

ptosis of the left eyelid and the left eye is shifted downward and laterally. There is reduced power and sensation in the upper and lower right limbs. A cerebellar examination is unremarkable however the patient reports feeling nauseated during past-pointing assessment due to his double vision. What is the most likely diagnosis?

Answer 55

webers syndrome an ipsilateral CN III palsy and contralateral hemiparesis

Question 56

what medication is sometimes used as an adjunct to antibiotics in meningitis?

Answer 56

IV dexamethasone This patient has no signs of systemic infection (rash/meningococcal septicemia), and the infection is unrelated to surgery,

Question 57

Multiple sclerosis patient with bladder dysfunction. urine dip is normal. next step in management?

Answer 57

get an ultrasound first to assess bladder emptying

Question 58

a burning sensation across the outside of her left thigh. It is causing her pain when she moves, especially whilst standing at work. The pain does not radiate anywhere else. most likely diagnosis/

Answer 58

Meralgia parasthetica - pain in lateral cutaneous nerve distribution. sudden weight gain is risk factor L3 lumbar radiculopathy causes pain but also typically presents with muscle weakness.!!! sciatica = shooting or shock-like and radiates from the back to the posterior leg and buttock. Sciatica may be associated with muscle weakness and other neurological signs.

Question 59

management of myaesthenic crisis? normal routine management of myaesthenia gravis?

Answer 59

Plasmapheresis and intravenous immunoglobulin - eg ITU with acute dyspnea long-acting acetylcholinesterase inhibitors pyridostigmine is first-line - immediate relief in a patient with symptoms but not in crisis

Question 60

SIADH is a common consequence of which neurological presentation?

Answer 60

subarachnoid hemorrhage

Question 61

A 59-year-old gentleman presents to the Emergency Department with a left sided hemiparesis which affects his lower limb more than his upper limb, with his face unaffected. He also has complete loss of both pain and light touch sensation in his left lower limb. He is able to clearly speak to you and understands what you say and does not have an ataxia, but he appears unable to see you when you stand on his left. Clinical examination of his visual fields reveals a left sided homonymous hemianopia. Which clinical stroke syndrome does he have?

Answer 61

partial anterior circulation infarct!!! unilateral hemiparesis and or hemisensory loss present homonynous hemianopia present = partial!! disruption of higher cognitive function eg dysphagia is required to bring about TOTAL anterior circulation infarct

Question 62

A 59-year-old man presents to his general practitioner with complaints of facial pain, which is triggered by smoking. He describes the pain as shock-like in sensation, located in the maxillary area and extending to his temple. There is no facial asymmetry and his vision is unimpaired. Systemically, he reports feeling well. His medical history includes relapsing-remitting multiple sclerosis and asthma. What is the most appropriate medication to initiate for this patient?

Answer 62

carbamezapine!!! first line for trigeminal neuralgia red flag symptoms/signs suggesting underlying cause- requires either admission or urgent referral for specialist assessment

Question 63

which structure is divided in surgical management of carpal tunnel syndrome?

Answer 63

flexor retinaculum

Question 64

There is a loss of sensation over the anterior aspect of the left knee and medial malleolus with reduced patellar reflex. What nerve root is most likely affected?

Answer 64

L4!!! although L3 and L4 both cause weak knee extension, L3 causes sensory loss over anterior THIGH

Question 65

which sign differentiates between organic and non-organic lower leg weakness?

Answer 65

Hoover's sign

Question 66

diabetic neuropathy with BPH, which drug would you avoid for treatment?

Answer 66

amytriptiline -> risk of urinary retention

Question 67

A 40-year-old woman presents with recurrent episodes of vertigo associated with a feeling or 'fullness' and 'pressure' in her ears. She thinks her hearing is worse during these attacks. Clinical examination is unremarkable. What is the most likely diagnosis?

Answer 67

recurrent episodes of vertigo, fluctuating sensorineural hearing loss, and a sensation of fullness or pressure in the affected ear. These symptoms result from an accumulation of endolymphatic fluid within the inner ear

Question 68

which one of the following statements regarding the stopping of anti-epileptic drugs (AED) is most correct?

Answer 68

Can be considered if seizure free for > 2 years, with AEDs being stopped over 2-3 months

Question 69

tia symptoms ct head, glucose, carotid doppler, of these what is most appropriate next investigation? patient takes clopidogrel etc

Answer 69

glucose!!

Question 70

A 64-year-old woman with a background of rheumatoid arthritis now presents with a high-stepping gait and an inability to dorsiflex her left foot. The foot is not painful. On examination she is systemically well. There is reduced tone in the left foot but no pain on passive movement of the joint. There is no pain on straight leg raise and hip abduction is normal. Plantars are downgoing. There is some sensory loss over the dorsum of the left foot and the lateral left lower leg. What is the most likely pathology?

Answer 70

common peroneal nerve palsy - RA is risk factor absence of pain on straight leg raise makes L5 radiculopathy less likely. Hip abductors are also likely to be weak (L5, superior gluteal nerve).

Question 71

preferred modality in patients with suspected TIA who require brain imaging

Answer 71

MRI brain with diffusion-weighted imaging

Question 72

get the stroke criteria right between thrombectomy and alteplase

Question 73

scan shows the presence of a bony growth extending from the C7 vertebrae unilaterally. While not immediately concerning, this could cause problems for the patient in future. Which condition is more likely to develop in this patient?

Answer 73

thoracic outlet syndrome! patient has a cervical rib pain, weakness and pallor of the affected arm are complications

Question 74

suspected meningitis, gram negative diplococci, most likely organism?

Answer 74

neissseria meningitidis

Question 75

pabrinex = IV vitamin B substances with ascorbic acid

Question 76

Atherosclerosis of the left internal carotis -> retinal/opthalmic artery -> left sided amaurosis fugax

Question 77

A 45-year-old woman presents with a 7-hour history of acute, severe headache, photophobia, and neck stiffness. She has a history of migraines but notes that this headache is different, having developed suddenly over minutes and being much worse than usual. On examination, she has neck stiffness and photophobia but is afebrile, with no rashes or focal neurological deficits. Her pupils are equal and reactive, and she has had no seizures. A CT head scan is performed and is normal. Which option is the most appropriate next step?

Answer 77

Lumbar puncture at 12 hours post-onset SAH can present with signs of meningism patient is afebrile and sudden onset points away from meningitis

Question 78

finding in nerve conduction evaluation of patients with carpal tunnels?

Answer 78

Action potential prolongation in both sensory and motor axons

Question 79

A 28-year-old man from Zimbabwe presents to the emergency department with a 2 week history of fever, cough, headache, vomiting and neck stiffness. He is known to be HIV positive and is on treatment. His most recent CD4 count was 450 cells/mm³ lymphocytic CSF with high protein and low glucose most likley type of meningitis?

Answer 79

Tb meningitis glucose is normal in viral meningitis

Question 80

pregnancy is a severe risk factor for bells palsy

Question 81

absence siezures treatment? focal siezures?

Answer 81

ethusuximide lamotrigine/levitracetam

Question 82

A 12-month-old baby with cerebral palsy is brought to the GP with her mother for a routine checkup. The mother reports feeding difficulties and has concerns about developmental delay. She also mentions continuous slow writhing movements of her limbs throughout the day. Based on the type of cerebral palsy seen in this child, what area of the brain is affected?

Answer 82

Basal ganglia and substantia nigra -> dyskinetic cerebral palsy versus: upper motor neurons -> spastic cerebellum damage -> ataxic

Question 83

meningitis His pupils are unequal and unreactive to light. During the examination, he experiences a generalised tonic-clonic seizure which resolves spontaneously after 2 minutes. most appropriate sequence of management steps

Answer 83

IV antibiotics, then neuro imaging, then consider lumbar puncture only because he has signs of raised ICP so you need the imaging before doing a lumbar puncture

Question 84

baclofen and what other drug are first line in MS spasticity?

Answer 84

gabapentin!! note gabapentin alone is first line for Oscillopsia (visual fields appear to oscillate)

Question 85

weakness and numbness of her hand. The symptoms get worse when she raises her hands above her head. The numbness is generalised and not confined to any particular dermatome. She is also complaining of a painful neck and generalised headache. She is a keen tennis player and is upset as she cannot even grip her racket properly. She also describes her fingers turning white in the cold. On examination there is wasting in her thenar eminence. No other focal neurology is found. Which of the following is the most likely cause of her symptoms?

Answer 85

thoracic outlet syndrome!!

Question 86

Nystagmus, which refers to involuntary eye movements often seen during acute attacks of vertigo, can also occur in patients suffering from Meniere's disease.

Question 87

Intracerebral haemorrhage is an uncommon but serious complication of thrombolysis in an acute ischemic stroke. management?

Answer 87

Stop Aspirin 300mg / all anticoagulation & control BP

Question 88

What is the most common clinical pattern seen in motor neuron disease?

Answer 88

Amyotrophic lateral sclerosis

Question 89

A 40-year-old man presents to the emergency department reporting episodes of blurred vision when reading. The episodes last between three to ten hours and are brought on shortly after, or during, exercise. The patient has a past medical history of relapsing-remitting multiple sclerosis most likely explanation?

Answer 89

Uhthoff 's phenomenon!!! where neurological symptoms are exacerbated by increases in body temperature is typically associated with multiple sclerosis Lhermitte's sign is incorrect. This is a sign also seen in MS but describes the shooting pain some patients experience while in neck extension.

Question 90

A 56-year-old woman with myasthenia gravis is due for an elective abdominal hysterectomy. Which commonly used anaesthetic agent would she most likely be resistant to?

Answer 90

Suxamethonium

Question 91

A 25-year-old man attends with a 3-month history of numbness in his right hand. On examination, you note the loss of sensation to the palmar and dorsal aspect of the 5th digit. Sensation of the forearm is preserved. What is the most likely diagnosis?

Answer 91

cubital tunnel syndrome!!! -> ulnar nerve C8/T1 radiculopathy is incorrect. C8/T1 radiculopathy can mimic ulnar nerve neuropathy. In this case, the preserved sensation of the forearm favours a diagnosis of cubital tunnel syndrome. The ulnar nerve does not provide sensation to the medial forearm, which is innervated by the medial antebrachial cutaneous nerve (C8 and T1).

Question 92

menieres disease prophylaxis? acute treatment?

Answer 92

betahistine prochlorperazine

Question 93

a transient episode of weakness but imagining showing infarction = stroke

Question 94

history of right-sided weakness and slurred speech. Her blood pressure is 210/120 mmHg, and her heart rate is 101 beats per minute. An urgent CT scan of the brain excludes haemorrhagic stroke, and aspirin is promptly administered. The neurology team assesses her as meeting the standard criteria for thrombolysis. What is the most appropriate next step in her management?

Answer 94

lower blood pressure Hypertension (>185/110 mmHg) in the setting of acute ischaemic stroke should be treated prior to thrombolysis

Question 95

neurogenic thoracic outlet syndrome more common than arterial thoracic outlet syndrome Arterial thoracic outlet syndrome is the least common subtype of thoracic outlet syndrome and would often cause pain, cold sensitivities and poor circulation in the hands

Question 96

A 48-year-old type 2 diabetic complains of numbness in his left arm and leg. Otherwise there is no other neurological signs. most likely type of stroke?

Answer 96

lacunar infarct -> isolated hemisensory loss is a sign

Question 97

woman, rapid bilateral upper and lower limb muscle contraction and relaxation lasting around 10 seconds before stopping. drug to start on?

Answer 97

Levetiracetam!!! -> first line in females for MYOCLONIC seizures

Question 98

Multiple sclerosis treatment?

Answer 98

- relapse = oral or IV methylprednisolone - DMARds - interferons. Natalizumabe ocrelizumab