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Question 1
Incorrect
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A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?
Your Answer: Subdural haematoma
Correct Answer: Extradural haematoma
Explanation:A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.
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This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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Which of the following signs suggests an absence seizure instead of a partial complex seizure?
Your Answer: Postictal confusion
Correct Answer: Induction by hyperventilation
Explanation:Absence seizures are induced by over breathing or hyperventilation, while the other features suggest partial seizures.
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This question is part of the following fields:
- Neurology
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Question 3
Incorrect
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A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?
Your Answer: Clomipramine
Correct Answer: Modafinil
Explanation:Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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Neurofibromatosis is characterised by which of the following?
Your Answer: Haemangiomas of the retina
Correct Answer: Scoliosis
Explanation:Neurofibromatosis (aka Von Recklinghausen’s disease) includes: neurofibrosarcomas, pheochromocytoma, optic nerve tumours, scoliosis and acoustic neuromas.
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This question is part of the following fields:
- Neurology
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Question 5
Correct
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A 12-year old girl was brought to the hospital with recurrent headaches for 6 months. Her physical examination revealed no abnormality. A CT scan of the head revealed a suprasellar mass with calcifications, eroding the surrounding sella turcica. The lesion is likely to represent:
Your Answer: Craniopharyngioma
Explanation:Craniopharyngiomas (also known as Rathke pouch tumours, adamantinomas or hypophyseal duct tumours) affect children mainly between the age of 5 and 10 years. It constitutes 9% of brain tumours affecting the paediatric population. These are slow-growing tumours which can also be cystic, and arise from the pituitary stalk, specifically the nests of epithelium derived from Rathke’s pouch. Histologically, this tumour shows nests of squamous epithelium which is lined on the outside by radially arranged cells. Calcium deposition is often seen with a papillary type of architecture.
ACTH-secreting pituitary adenomas are rare and mostly microadenomas. Paediatric astrocytoma’s usually occur in the posterior fossa. Although null cell adenomas can cause mass effect and give rise to the described symptoms, they are not suprasellar. Prolactinomas can also show symptoms of headache and disturbances in the visual field, however they are known to be small and slow-growing. -
This question is part of the following fields:
- Neurology
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Question 6
Incorrect
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A 7-month-old abandoned baby with congenital non-communicating hydrocephalus is hosted by a clinic at its new-born hostel. A CT scan of the baby's brain reveals what might be a blockage of the ventricular system between the third and the fourth ventricles. Which of the following is the most likely blocked structure?
Your Answer: Foramen of Magendie
Correct Answer: Cerebral aqueduct
Explanation:The drainage of cerebral spinal fluid from the third ventricle to the fourth ventricle is carried out by the cerebral aqueduct. The cerebral aqueduct is the narrowest passageway in the entire ventricular system and thus forms the most common site of blockage of flow of cerebrospinal fluid. The interventricular foramen allows passage of CSF to the third ventricle. The foramen of Luschka and Magendie are located on the fourth ventricle and allow passage of CSF to the subarachnoid space from the ventricular system. The pontine cistern is a space located on the ventral aspect of the pons. The cisterna magna is an opening on the subarachnoid space between the pia matter and the arachnoid.
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This question is part of the following fields:
- Neurology
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Question 7
Incorrect
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A 2 year old female was taken to her local emergency department with jerking movements in her limbs. This lasted for around 10 seconds, and then she fell unconscious. She soon regained consciousness - she was disorientated but afebrile with no symptoms of meningeal irritation. From the list of options, chose the most appropriate investigation route for this patient.
Your Answer: CT scan
Correct Answer: 24 hour EEG
Explanation:Many of the symptoms favour an epilepsy diagnosis: uncontrollable jerking of the limbs and a loss of consciousness. A 24-hour EEG is used to diagnose epilepsy.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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A 17-year-old girl presented with fever, headache and photophobia. Cerebrospinal fluid examination reveals:Opening pressure 260 mm H20 (50-180)Total protein 0.8 g/l (0.15-0.45)Glucose 4.2 mmol/l (3.3-4.4)White cell count 60 per ml (<5)Lymphocytes 90%Plasma glucose 6.4 mmol/l (3.0-6.0)Which of the following is the most likely diagnosis?
Your Answer: Cryptococcal meningitis
Correct Answer: Viral meningitis
Explanation:Normal cerebrospinal fluid (CSF) glucose together with lymphocytosis, an increased opening pressure and raised CSF protein are typical of a viral meningitis.
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This question is part of the following fields:
- Neurology
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Question 9
Incorrect
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An 18 year old, previously well boy was admitted following a generalized tonic-clonic convulsion for 5 minutes with urinary incontinence and eye rolling. On examination, he was drowsy and had bilateral up going plantar reflexes. A short while ago he had been playing rugby and had taken a hit to the head. He was apparently normal for a few minutes before fitting. His blood sugar level was normal. Which of the following is the most probable reason for this presentation?
Your Answer: Extradural haematoma
Correct Answer: Post-traumatic seizure
Explanation:The history is suggestive of a post-traumatic seizure which frequently occurs after moderate or severe traumatic brain injury. Although upgoing plantars can be identified in a post-ictal status, an intracranial bleed has to be excluded. A single seizure cannot be considered epilepsy
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This question is part of the following fields:
- Neurology
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Question 10
Correct
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An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?
Your Answer: Dandy-Walker syndrome
Explanation:Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.
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This question is part of the following fields:
- Neurology
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