1- A 23-year-old man presents with visual loss in the right eye, diagnosed as optic neuritis.
Which one of the following statements would be seen in an afferent pupillary defect?
1) accommodation response is unaffected
2) hypersensitive response to pilocarpine in the affected eye
3) irregular pupil of the affected eye
4) pupil of affected eye larger than the unaffected eye
5) pupil of affected eye smaller than the unaffected eye
2- A 75-year-old man presents with 12 months history of cognitive impairment, parkinsonism, intermittent confusion and generalised myoclonus. He was started on 62.5 tds of sinemet. In the following 2 months he was started experiencing visual hallucinations. The most likely diagnosis is:
1) Idiopathic Parkinson's disease
2) Alzheimer's disease
3) Diffuse Lewy body disease
4) Multiple system atrophy
5) Progressive supranuclear palsy
3-Which visual field defect is most likely to occur with multiple sclerosis?
1) bitemporal hemianopia
2) central scotoma
3) homonymous hemianopia
4) increased blind spot
5) tunnel vision
4- Which is true of herpes simplex encephalitis?
1) brain MRI is characteristically normal
2) fits are uncommon
3) genital herpes is usually present
4) temporal lobe involvement is common
5) viral identification using polymerase chain reaction on CSF is non-specific
5- Which of the following investigations best supports a diagnosis of new variant CJD:
1) CSF analysis
2) CT brain
3) EEG
4) EMG
5) MRI brain
6- Which of the following is a recognised cause of a phrenic nerve palsy?
1) Aortic aneurysm
2) Dermoid
3) Ganglioneuroma
4) Pericardial cyst
5) Sarcoidosis
7- A 33 year old epileptic female presents with visual problems. Examination reveals a constriction of visual fields to confrontation. Which of the following may be responsible for her visual deterioration?
1) Vigabatrin
2) Lamotrigine
3) Gabapentin
4) Phenytoin
5) Sodium Valproate
8- A 19 year old girl presents at the antenatal clinic. She is approximately six weeks pregnant and the pregnancy was unplanned. She has a two year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about her anticonvulsant therapy and the effects on the baby and enquires how she should be managed?
1) Advise termination due to drug teratogenicity
2) Continue with carbamazepine
3) Stop carbamazepine until the second trimester
4) Switch therapy to phenytoin
5) Switch therapy to sodium valproate
9- A female patient aged 30 has a 5 years history of difficulty getting upstairs and out of a low chair and mild upper limb weakness but no pain. There is no family history. She presented with severe type 2 respiratory failure. EMG showed evidence of myopathy. The most likely diagnosis is:
1) Polymyositis
2) Inclusion body myositis
3) Acid Maltase Deficiency
4) Miller-Fisher Syndrome
5) Lambert-Eaton Myasthenic Syndrome
10- A 75 year-old woman with acute monocular visual loss. Fundoscopy reveals a swollen pale optic disc in the affected eye. What is the mose likely diagnosis?
1) Central retinal vein occlusion.
2) Closed angle glaucoma.
3) Giant cell arteritis.
4) Optic neuritis.
5) Raised intracranial pressure.
11- A 45-year-old man presents with an insidious onset of binocular horizontal diplopia and left sided facial pain. On examination ha has a left abducens nerve palsy and numbness over the maxillary division of the left trigeminal nerve. The most likely anatomical site of his neurological lesion is:
1) Cavernous sinus
2) Petrous apex
3) Superior orbital fissure
4) Cerebellopontine angle
5) Midbrain
12- An adloescent boy presents with unexplained neurological illness.Which one of the following would suggest substance abuse?
1) A history of low self-esteem.
2) A history of social isolation.
3) Deposits around the mouth.
4) A history of family conflict.
5) A history of attention deficit disorder.
13- A 45-year-old woman noticed tinnitus in her left ear which progressed over some weeks to hearing loss in that ear. On physical examination she is found to have a marked decrease in hearing on the left, with Rinne test indicating air conduction better than bone conduction. The other cranial nerves I - VII and IX - XII are intact. A brain MRI scan revealed a solitary, fairly discreet, 3 cm mass located in the region of the left cerebellopontine angle. Which of the following
statements is most appropriate to tell the patient regarding these findings?
1) A test for HIV-1 is likely to be positive
2) Other family members should undergo MR imaging of the brain
3) Remissions and exacerbations are likely to occur in coming years
4) The lesion can be resected with a good prognosis
5) You are unlikely to survive for more than a year
14- A 22-year-old man suffers a deep laceration to the forearm resulting in transection of the median nerve. Following this injury, the nerve will undergo which of the following pathological processes?
1) Chronic inflammation
2) Coagulative necrosis
3) Fibrinoid necrosis
4) Segmental demyelination
5) Wallerian degeneration
15- Which of the following features is characteristic of myasthenia gravis?
1) Diplopia
2) Equal sex incidence
3) Fasciculation
4) Lid lag
5) Loss of pupillary reflexes
Which one of the following statements would be seen in an afferent pupillary defect?
1) accommodation response is unaffected
2) hypersensitive response to pilocarpine in the affected eye
3) irregular pupil of the affected eye
4) pupil of affected eye larger than the unaffected eye
5) pupil of affected eye smaller than the unaffected eye
2- A 75-year-old man presents with 12 months history of cognitive impairment, parkinsonism, intermittent confusion and generalised myoclonus. He was started on 62.5 tds of sinemet. In the following 2 months he was started experiencing visual hallucinations. The most likely diagnosis is:
1) Idiopathic Parkinson's disease
2) Alzheimer's disease
3) Diffuse Lewy body disease
4) Multiple system atrophy
5) Progressive supranuclear palsy
3-Which visual field defect is most likely to occur with multiple sclerosis?
1) bitemporal hemianopia
2) central scotoma
3) homonymous hemianopia
4) increased blind spot
5) tunnel vision
4- Which is true of herpes simplex encephalitis?
1) brain MRI is characteristically normal
2) fits are uncommon
3) genital herpes is usually present
4) temporal lobe involvement is common
5) viral identification using polymerase chain reaction on CSF is non-specific
5- Which of the following investigations best supports a diagnosis of new variant CJD:
1) CSF analysis
2) CT brain
3) EEG
4) EMG
5) MRI brain
6- Which of the following is a recognised cause of a phrenic nerve palsy?
1) Aortic aneurysm
2) Dermoid
3) Ganglioneuroma
4) Pericardial cyst
5) Sarcoidosis
7- A 33 year old epileptic female presents with visual problems. Examination reveals a constriction of visual fields to confrontation. Which of the following may be responsible for her visual deterioration?
1) Vigabatrin
2) Lamotrigine
3) Gabapentin
4) Phenytoin
5) Sodium Valproate
8- A 19 year old girl presents at the antenatal clinic. She is approximately six weeks pregnant and the pregnancy was unplanned. She has a two year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately six months. She wants to continue with her pregnancy if it is safe to do so. She is worried about her anticonvulsant therapy and the effects on the baby and enquires how she should be managed?
1) Advise termination due to drug teratogenicity
2) Continue with carbamazepine
3) Stop carbamazepine until the second trimester
4) Switch therapy to phenytoin
5) Switch therapy to sodium valproate
9- A female patient aged 30 has a 5 years history of difficulty getting upstairs and out of a low chair and mild upper limb weakness but no pain. There is no family history. She presented with severe type 2 respiratory failure. EMG showed evidence of myopathy. The most likely diagnosis is:
1) Polymyositis
2) Inclusion body myositis
3) Acid Maltase Deficiency
4) Miller-Fisher Syndrome
5) Lambert-Eaton Myasthenic Syndrome
10- A 75 year-old woman with acute monocular visual loss. Fundoscopy reveals a swollen pale optic disc in the affected eye. What is the mose likely diagnosis?
1) Central retinal vein occlusion.
2) Closed angle glaucoma.
3) Giant cell arteritis.
4) Optic neuritis.
5) Raised intracranial pressure.
11- A 45-year-old man presents with an insidious onset of binocular horizontal diplopia and left sided facial pain. On examination ha has a left abducens nerve palsy and numbness over the maxillary division of the left trigeminal nerve. The most likely anatomical site of his neurological lesion is:
1) Cavernous sinus
2) Petrous apex
3) Superior orbital fissure
4) Cerebellopontine angle
5) Midbrain
12- An adloescent boy presents with unexplained neurological illness.Which one of the following would suggest substance abuse?
1) A history of low self-esteem.
2) A history of social isolation.
3) Deposits around the mouth.
4) A history of family conflict.
5) A history of attention deficit disorder.
13- A 45-year-old woman noticed tinnitus in her left ear which progressed over some weeks to hearing loss in that ear. On physical examination she is found to have a marked decrease in hearing on the left, with Rinne test indicating air conduction better than bone conduction. The other cranial nerves I - VII and IX - XII are intact. A brain MRI scan revealed a solitary, fairly discreet, 3 cm mass located in the region of the left cerebellopontine angle. Which of the following
statements is most appropriate to tell the patient regarding these findings?
1) A test for HIV-1 is likely to be positive
2) Other family members should undergo MR imaging of the brain
3) Remissions and exacerbations are likely to occur in coming years
4) The lesion can be resected with a good prognosis
5) You are unlikely to survive for more than a year
14- A 22-year-old man suffers a deep laceration to the forearm resulting in transection of the median nerve. Following this injury, the nerve will undergo which of the following pathological processes?
1) Chronic inflammation
2) Coagulative necrosis
3) Fibrinoid necrosis
4) Segmental demyelination
5) Wallerian degeneration
15- Which of the following features is characteristic of myasthenia gravis?
1) Diplopia
2) Equal sex incidence
3) Fasciculation
4) Lid lag
5) Loss of pupillary reflexes
16- A 25-year-old woman presents with a severe migraine. Which of the following is not a recognised feature of migraine?
1) Some symptoms improved by tricyclic antidepressants
2) Third nerve palsy
3) External opthalmoplegia
4) bilateral fortification spectra
5) precipitation by oral contraceptives
17- A 48-year-old female patient develops an acute, severe and isolated right C6 radiculopathy affecting both the motor and sensory roots. She is examined in an EMG clinic 3 weeks after the onset of symptoms. Which of the following statements is true?
1) Absent sensory nerve potentials would be expected on examination of the thumb and index finger on the right.
2) A repeat examination 12 months later is likely to reveal rapidly recruited low amplitude short duration motor units in the clinically involved muscle on EMG.
3) Fibrillation potentials would be expected in the right brachioradialis and abductor pollicus brevis.
4) Triceps tendon jerk is likely to be depressed or absent.
5) Voluntary motor unit activity may be absent in the right biceps.
18 - A 15 year old boy presents with tremor of both hands. Over the previous months he has eveloped a mild dysarthria. He has a history of behavioural problems, of a depressive/psychotic nature. The most likely diagnosis is:
1) Alzheimer's disease
2) Huntington's disease
3) Neuroacanthocytosis
4) variant Creutzfeldt-Jakob disease
5) Wilson's disease
19- A 24 year old female presents with vague frontal headaches and visual disturbance. She has a past history of acne for which she is receiving treatment. Examination reveals her to be obese with a blood pressure of 110/70 mmHg. There is absence of the central retinal vein pulsation on fundoscopic examination. Which of the following drugs account for these findings?
1) Isotretinoin
2) Ampicillin
3) Topical tetracycline
4) Dianette
5) Erythromycin
20- Which of the following is true of human neurons?
1) myelin sheaths extend across the nodes of Ranvier.
2) unmyelinated fibres have faster conduction.
3) sodium ion influx occurs during the action potential.
4) the action potential increases with increased stimulation.
5) increased extracellular calcium leads to increased neuronal excitability.
21- A 34 year old male presents with back-pain and weakness. Which of the following would support a diagnosis of prolapsed intervertebral disc?
1) bilateral symmetrical nerve involvement
2) Loss of sensation over the left outer upper thigh
3) no evidence of nerve compression
4) pain which is worse on resting
5) pain which is unremitting in character
22- The anticonvulsant Levetiracetecam
1) Is used as monotherapy for the treatment of generalised convulsions
2) Acts via the GABA receptor
3) Is associated with induction of hepatic cytochrome p450 enzymes
4) Is well absorbed via the oral route
5) Is associated with increased plasma concentrations of sodium valproate
23- Following factors decrease large intestinal motility:
1) Parasympathetic activity
2) Anticholinergic agents
3) Gastric Distension
4) CCK-PZ
5) Laxatives.
24- A 72 year old female presents with general slowness. Examination reveals a tremor of the hands. What frequency of tremor would you suspect in Parkinson's disease?
1) 1 Hz
2) 2 Hz
3) 5 Hz
4) 8 Hz
5) 10 Hz
25- Which statement is true regarding Gabapentin?
1) is a potent hepatic enzyme inducer
2) side effects typically include visual field defects with long-term use
3) therapy is best monitored through measuring plasma concentrations
4) is of particular value as monotherapy in absence attacks (petit mal)
5) requires dose adjustment in renal disease
26- A 62-year-old man presented with difficult walking. He had a past history of diabetes mellitus and cervical spondylosis, which had required surgical decompression eight years previously. He drank 40 units of alcohol weekly. On examination there was fasciculation, wasting and weakness in the left deltoid and biceps, with weakness in the shoulder girdle muscles bilaterally. There was fasciculation in the glutei and quadriceps bilaterally, weakness of hip flexion and foot dorsiflexion,
brisk reflexes in upper and lower limbs, and extensor plantar responses. There was no sensory impairment.What is the diagnosis?
1) alcoholic myopathy
2) diabetic amyotrophy
3) motor neurone disease
4) recurrent cervical cord compression
5) syringomyelia
27- Which of the following is least likely to cause choreiform movements?
1) polyarteritis nodosa
2) polycythaemia rubra vera
3) Rheumatic fever
4) systemic lupus erythematosus
5) thyrotoxicosis
28- A 24-year-old man presents with a five month history of low back pain, radiating to his buttocks, and back stiffness worse in the morning and worse after periods of inactivity. Which of the following signs is the most likely to be present?
1) exaggerated lumbar lordosis
2) positive femoral stretch test
3) positive Trendelenburg test
4) restricted straight leg raising
5) sacroiliac joint tenderness
29- A previously well 27-year-old woman presents with a history of transient ischaemic attack affecting her right side and speech. She had returned to the United Kingdom from a holiday in New Zealand two days previously. On examination there was nothing abnormal to find. An ECG, chest X-ray, CT brain scan and routine haematology and biochemistry were all normal. What is the most likely underlying abnormality?
1) atrial myxoma
2) carotid artery stenosis
3) embolus from paroxysmal atrial fibrillation
4) patent foramen ovale
5) subarachnoid haemorrhage
30- Which of the following factors is the most likely to account for this problem?
1) altered volume of distribution
2) delayed gastric emptying
3) first pass metabolism
4) hepatic enzyme induction
5) reduced gut blood flow
1) Some symptoms improved by tricyclic antidepressants
2) Third nerve palsy
3) External opthalmoplegia
4) bilateral fortification spectra
5) precipitation by oral contraceptives
17- A 48-year-old female patient develops an acute, severe and isolated right C6 radiculopathy affecting both the motor and sensory roots. She is examined in an EMG clinic 3 weeks after the onset of symptoms. Which of the following statements is true?
1) Absent sensory nerve potentials would be expected on examination of the thumb and index finger on the right.
2) A repeat examination 12 months later is likely to reveal rapidly recruited low amplitude short duration motor units in the clinically involved muscle on EMG.
3) Fibrillation potentials would be expected in the right brachioradialis and abductor pollicus brevis.
4) Triceps tendon jerk is likely to be depressed or absent.
5) Voluntary motor unit activity may be absent in the right biceps.
18 - A 15 year old boy presents with tremor of both hands. Over the previous months he has eveloped a mild dysarthria. He has a history of behavioural problems, of a depressive/psychotic nature. The most likely diagnosis is:
1) Alzheimer's disease
2) Huntington's disease
3) Neuroacanthocytosis
4) variant Creutzfeldt-Jakob disease
5) Wilson's disease
19- A 24 year old female presents with vague frontal headaches and visual disturbance. She has a past history of acne for which she is receiving treatment. Examination reveals her to be obese with a blood pressure of 110/70 mmHg. There is absence of the central retinal vein pulsation on fundoscopic examination. Which of the following drugs account for these findings?
1) Isotretinoin
2) Ampicillin
3) Topical tetracycline
4) Dianette
5) Erythromycin
20- Which of the following is true of human neurons?
1) myelin sheaths extend across the nodes of Ranvier.
2) unmyelinated fibres have faster conduction.
3) sodium ion influx occurs during the action potential.
4) the action potential increases with increased stimulation.
5) increased extracellular calcium leads to increased neuronal excitability.
21- A 34 year old male presents with back-pain and weakness. Which of the following would support a diagnosis of prolapsed intervertebral disc?
1) bilateral symmetrical nerve involvement
2) Loss of sensation over the left outer upper thigh
3) no evidence of nerve compression
4) pain which is worse on resting
5) pain which is unremitting in character
22- The anticonvulsant Levetiracetecam
1) Is used as monotherapy for the treatment of generalised convulsions
2) Acts via the GABA receptor
3) Is associated with induction of hepatic cytochrome p450 enzymes
4) Is well absorbed via the oral route
5) Is associated with increased plasma concentrations of sodium valproate
23- Following factors decrease large intestinal motility:
1) Parasympathetic activity
2) Anticholinergic agents
3) Gastric Distension
4) CCK-PZ
5) Laxatives.
24- A 72 year old female presents with general slowness. Examination reveals a tremor of the hands. What frequency of tremor would you suspect in Parkinson's disease?
1) 1 Hz
2) 2 Hz
3) 5 Hz
4) 8 Hz
5) 10 Hz
25- Which statement is true regarding Gabapentin?
1) is a potent hepatic enzyme inducer
2) side effects typically include visual field defects with long-term use
3) therapy is best monitored through measuring plasma concentrations
4) is of particular value as monotherapy in absence attacks (petit mal)
5) requires dose adjustment in renal disease
26- A 62-year-old man presented with difficult walking. He had a past history of diabetes mellitus and cervical spondylosis, which had required surgical decompression eight years previously. He drank 40 units of alcohol weekly. On examination there was fasciculation, wasting and weakness in the left deltoid and biceps, with weakness in the shoulder girdle muscles bilaterally. There was fasciculation in the glutei and quadriceps bilaterally, weakness of hip flexion and foot dorsiflexion,
brisk reflexes in upper and lower limbs, and extensor plantar responses. There was no sensory impairment.What is the diagnosis?
1) alcoholic myopathy
2) diabetic amyotrophy
3) motor neurone disease
4) recurrent cervical cord compression
5) syringomyelia
27- Which of the following is least likely to cause choreiform movements?
1) polyarteritis nodosa
2) polycythaemia rubra vera
3) Rheumatic fever
4) systemic lupus erythematosus
5) thyrotoxicosis
28- A 24-year-old man presents with a five month history of low back pain, radiating to his buttocks, and back stiffness worse in the morning and worse after periods of inactivity. Which of the following signs is the most likely to be present?
1) exaggerated lumbar lordosis
2) positive femoral stretch test
3) positive Trendelenburg test
4) restricted straight leg raising
5) sacroiliac joint tenderness
29- A previously well 27-year-old woman presents with a history of transient ischaemic attack affecting her right side and speech. She had returned to the United Kingdom from a holiday in New Zealand two days previously. On examination there was nothing abnormal to find. An ECG, chest X-ray, CT brain scan and routine haematology and biochemistry were all normal. What is the most likely underlying abnormality?
1) atrial myxoma
2) carotid artery stenosis
3) embolus from paroxysmal atrial fibrillation
4) patent foramen ovale
5) subarachnoid haemorrhage
30- Which of the following factors is the most likely to account for this problem?
1) altered volume of distribution
2) delayed gastric emptying
3) first pass metabolism
4) hepatic enzyme induction
5) reduced gut blood flow
31- A 25-year-old female presents with 2 days history of diplopia and unsteadiness. 2 weeks ago she suffered an upper respiratory tract infection. On examination there is complete opthalmoplegia, areflexia and gait ataxia. Which of the following blood tests is the most likely to confirm the underlying diagnosis?
1) Acetylcholine receptors antibodies
2) Anti GM1 antibodies
3) Anti GQib antibodies
4) Anti Hu antibodies
5) Anti purkinje cell antibodies
32- Which of the following is true of tetanus?
1) failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
2) infection confers lifelong immunity
3) there is a characteristic EEG
4) Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
5) cephalic tetanus causes severe dysphagia
33- A 68-year-old man presents with progressive visual impairment. On examination there is an incongruous homonymous hemianopia. The most likely anatomical site of the neurological lesion is at:
1) optic nerve
2) optic tract
3) chiasma
4) optic radiation
5) occipital lobe
34- A 21 year old female with epilepsy is well controlled on sodium valproate 600mg bd and had been taking oral contraceptives for three years. She presented to her general practitioner 12 weeks pregnant. Which of the following is correct?
1) An alternative anticonvulsant should be used in place of sodium valproate
2) Interaction of sodium valproate with the oral contraceptive increased the risk of pregnancy
3) The dose of sodium valproate should be increased
4) There is an increased risk of a neural tube defect in her fetus
5) She is at increased risk of anaemia in pregnancy
35- A 40-year-old man has had decreased mentation with confusion as well as increasing incoordination and loss of movement in his right arm over the past 6 weeks. An MRI scan shows 0.5 to 1.5 cm lesions in cerebral hemispheres in white matter and at the grey-white junction that suggest demyelination. A stereotatic biopsy is performed, and immunohistochemical staining of the tissue reveals JC papovavirus in oligodendrocytes. Which of the following laboratory test findings is most
likely to be associated with these findings?
1) CD4 lymphocyte count of 90/microliter
2) Haemoglobin A1c of 9.8%
3) HDL cholesterol of 0.7 mmol/L
4) Oligoclonal bands in CSF
5) Serum sodium of 110 mmol/L
36- A 60-year-old man presents with an episode of memory loss. Three days earlier he had become confused. His wife led him into the house - he apparently sat down at her request, and had a cup of tea. He then wandered around the house, confused, but remained conscious and able to have some conversation with his wife, though continuing to ask similar questions repeatedly. After three hours, he abruptly returned to normal and had no recollection of the events. What is the most likely
diagnosis?
1) alcohol related amnesia
2) chronic subdural haematoma
3) complex partial status epilepticus
4) hysterical fugue state
5) transient global amnesia
37- A 65-year-old man presents with 4 months history of swallowing difficulties (worse with liquids than solids). He also complains of nasal regurgitation, coughing and choking episodes during meals and slight dysarthria. He lost 1 stone over the last 8 weeks. Which of the following investigations is the most appropriate for this case?
1) Gastroscopy
2) Barium swallow
3) CXR
4) Tumour markers
5) Acetyl choline receptors antibodies
38 - A complete unilateral facial hemiparesis may be caused by which of the following?
1) An intracranial tumour
2) Birth injury
3) Cerebellar atrophy
4) Myasthenia gravis
5) Phenothiazine toxicity
39- Regarding pseudotumours cerebri (benign hypercranial hypertension) which is true?
1) A mildly increased CSF cell count is typical.
2) May be caused by prolonged steriod therapy.
3) Is occasionally associated with focal neurological signs.
4) Frequently presents with ataxia.
5) Is distinguished from hydrocephalus by the absence of suture separation.
40- Which of the following associations is correct?
1) Renal transplantation and Non-Hodgkin's lymphoma
2) Hepatitis B and aplastic anaemia
3) Turner's syndrome and acute myeloid leukaemia
4) Basophilia and chronic myeloid leukaemia
5) Crohn's disease and TB
41- A demyelinating polyneuropathy is typically caused by:
1) Diabetes
2) Excessive alcohol
3) Hereditary motor-sensory neuropathy
4) Renal failure
5) Vitamin B12 deficiency
42- Causes of dilated pupils include:
1) Argyll Robertson pupil
2) Ethylene glycol poisoning
3) Myotonic dystrophy
4) Organophosphate poisoning
5) Pontine haemorrhage
43- Which ONE of the following would be expected in a third nerve palsy?
1) Enophthalmos
2) Constricted pupil
3) Convergent strabismus
4) Increased lacrimation
5) Unreactive pupil to light
44- A 20-year-old female presents with acute onset of left foot drop. Examination reveals weakness of ankle dorsiflexion and eversion. There is a small area of sensory loss in the first web space. Reflexes were all present and plantars flexor. Which of the following nerves is likely to be involved?
1) Tibial nerve
2) Common peroneal nerve
3) Sciatic nerve
4) Femoral nerve
5) Inferior gluteal nerve
45- Which of the following is a characteristic feature of transient global amnesia?
1) abnormal behaviour
2) apraxia
3) confabulation
4) loss of personal identity
5) normal perception
1) Acetylcholine receptors antibodies
2) Anti GM1 antibodies
3) Anti GQib antibodies
4) Anti Hu antibodies
5) Anti purkinje cell antibodies
32- Which of the following is true of tetanus?
1) failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
2) infection confers lifelong immunity
3) there is a characteristic EEG
4) Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
5) cephalic tetanus causes severe dysphagia
33- A 68-year-old man presents with progressive visual impairment. On examination there is an incongruous homonymous hemianopia. The most likely anatomical site of the neurological lesion is at:
1) optic nerve
2) optic tract
3) chiasma
4) optic radiation
5) occipital lobe
34- A 21 year old female with epilepsy is well controlled on sodium valproate 600mg bd and had been taking oral contraceptives for three years. She presented to her general practitioner 12 weeks pregnant. Which of the following is correct?
1) An alternative anticonvulsant should be used in place of sodium valproate
2) Interaction of sodium valproate with the oral contraceptive increased the risk of pregnancy
3) The dose of sodium valproate should be increased
4) There is an increased risk of a neural tube defect in her fetus
5) She is at increased risk of anaemia in pregnancy
35- A 40-year-old man has had decreased mentation with confusion as well as increasing incoordination and loss of movement in his right arm over the past 6 weeks. An MRI scan shows 0.5 to 1.5 cm lesions in cerebral hemispheres in white matter and at the grey-white junction that suggest demyelination. A stereotatic biopsy is performed, and immunohistochemical staining of the tissue reveals JC papovavirus in oligodendrocytes. Which of the following laboratory test findings is most
likely to be associated with these findings?
1) CD4 lymphocyte count of 90/microliter
2) Haemoglobin A1c of 9.8%
3) HDL cholesterol of 0.7 mmol/L
4) Oligoclonal bands in CSF
5) Serum sodium of 110 mmol/L
36- A 60-year-old man presents with an episode of memory loss. Three days earlier he had become confused. His wife led him into the house - he apparently sat down at her request, and had a cup of tea. He then wandered around the house, confused, but remained conscious and able to have some conversation with his wife, though continuing to ask similar questions repeatedly. After three hours, he abruptly returned to normal and had no recollection of the events. What is the most likely
diagnosis?
1) alcohol related amnesia
2) chronic subdural haematoma
3) complex partial status epilepticus
4) hysterical fugue state
5) transient global amnesia
37- A 65-year-old man presents with 4 months history of swallowing difficulties (worse with liquids than solids). He also complains of nasal regurgitation, coughing and choking episodes during meals and slight dysarthria. He lost 1 stone over the last 8 weeks. Which of the following investigations is the most appropriate for this case?
1) Gastroscopy
2) Barium swallow
3) CXR
4) Tumour markers
5) Acetyl choline receptors antibodies
38 - A complete unilateral facial hemiparesis may be caused by which of the following?
1) An intracranial tumour
2) Birth injury
3) Cerebellar atrophy
4) Myasthenia gravis
5) Phenothiazine toxicity
39- Regarding pseudotumours cerebri (benign hypercranial hypertension) which is true?
1) A mildly increased CSF cell count is typical.
2) May be caused by prolonged steriod therapy.
3) Is occasionally associated with focal neurological signs.
4) Frequently presents with ataxia.
5) Is distinguished from hydrocephalus by the absence of suture separation.
40- Which of the following associations is correct?
1) Renal transplantation and Non-Hodgkin's lymphoma
2) Hepatitis B and aplastic anaemia
3) Turner's syndrome and acute myeloid leukaemia
4) Basophilia and chronic myeloid leukaemia
5) Crohn's disease and TB
41- A demyelinating polyneuropathy is typically caused by:
1) Diabetes
2) Excessive alcohol
3) Hereditary motor-sensory neuropathy
4) Renal failure
5) Vitamin B12 deficiency
42- Causes of dilated pupils include:
1) Argyll Robertson pupil
2) Ethylene glycol poisoning
3) Myotonic dystrophy
4) Organophosphate poisoning
5) Pontine haemorrhage
43- Which ONE of the following would be expected in a third nerve palsy?
1) Enophthalmos
2) Constricted pupil
3) Convergent strabismus
4) Increased lacrimation
5) Unreactive pupil to light
44- A 20-year-old female presents with acute onset of left foot drop. Examination reveals weakness of ankle dorsiflexion and eversion. There is a small area of sensory loss in the first web space. Reflexes were all present and plantars flexor. Which of the following nerves is likely to be involved?
1) Tibial nerve
2) Common peroneal nerve
3) Sciatic nerve
4) Femoral nerve
5) Inferior gluteal nerve
45- Which of the following is a characteristic feature of transient global amnesia?
1) abnormal behaviour
2) apraxia
3) confabulation
4) loss of personal identity
5) normal perception
46- A lesion of the occipital lobe causes:
1) Acalculia
2) Astereogenesis
3) Constructional apraxia
4) Cortical blindness
5) Visuospatial neglect
47- A 17-year-old man has been diagnosed with schizophrenia 4 weeks ago. He was started on haloperidol. Two weeks later he was found confused and drowsy. On examination he was pyrexial (40.7 C), rigid with blood pressure of 200/100. Which of the following treatment will you initiate?
1) phenytoin
2) diazepam
3) cefuroxime
4) acyclovir
5) dantrolene
48- A 50 year-old male epileptic presents with paraesthesia of hands and feet. He also has unsteadiness when walking. On examination he has Dupytren's contracture in his left hand, a peripheral sensory neuropathy and palpable lymph nodes in his neck and axillae.
Which of the following drugs is the most likely cause of these features?
1) Carbamazepine.
2) Clonazepam
3) Lamotrigine.
4) Phenytoin.
5) Sodium valproate.
49- An 80-year-old woman has a three month history of progressive numbness and unsteadiness of her gait. On examination, there is a mild spastic paraparesis, with brisk knee reflexes, ankle reflexes are present with reinforcement, extensor plantars, sensory loss in the legs with a sensory level at T10, impaired joint position sense in the toes, and loss of vibration sense below the iliac crests.
Investigations were as follows:-
haemoglobin 12.0 g/dl
MCV 99 fl
What is the most likely diagnosis?
1) anterior spinal artery occlusion
2) dorsal meningioma
3) multiple sclerosis
4) subacute combined degeneration of the cord
5) tabes dorsalis
50- A 16 year old girl presented with a three week history of headache and horizontal diplopia on far right lateral gaze. On two separate occasions she noted dimmed vision whilst bending forwards. Over the last year she had gained 12 kilograms in weight. On examination, her weight was 95 kg, and height 162cms. Neurological examination revealed bilateral papilloedema and a partial right sixth cranial nerve palsy. What is the most likely diagnosis?
1) Benign intracranial hypertension.
2) Multiple sclerosis.
3) Pituitary tumour
4) Superior sagittal vein thrombosis.
5) Thyroid eye disease.
51- Which of the following clinical manifestations suggests Guillain Barré Syndrome?
1) Weakness beginning in the arms
2) Asymmetrical involvement of distal muscles
3) Bulbar involvement in about 50% of cases
4) Brisk tendon reflexes
5) Normal CSF protein
52- In herpes simplex encephalitis which of the following statements is correct?
1) brain MRI is characteristically normal
2) temporal lobe involvement is common
3) fits are uncommon
4) cold sores or genital herpes are usually present
5) viral identification by PCR on cerebrospinal fluid is non-specific
53- A 25 year-old lady recently diagnosed with rheumatoid arthritis. She has developed weakness, double vision and tiredness. Examination reveals bilateral weakness of eye abduction, bilateral ptosis, slightly reduced proximal motor power in the limbs, normal reflexes and sensation. What is the diagnosis?
1) Chronic progressive external opthalmoplegia.
2) Guillain-Barre syndrome.
3) Multiple sclerosis.
4) Myasthenia gravis.
5) Polymyositis
54- A 63 year old male is admitted with acute onset unsteadiness of gait, dizziness and dysphagia. Examination revealed a right-sided Horner's syndrome, nystagmus, loss of pain and temperature sensation on the left side of the trunk and in the left arm and leg, and gait ataxia.
What is the most likely diagnosis?
1) leaking posterior communicating artery aneurysm
2) left sided acoustic neuroma
3) posterior inferior cerebellar artery occlusion
4) right sided pontine infarct
5) spontaneous left sided cerebellar haemorrhage
55- Which of the following features are not compatible with the diagnosis of motor neuron disease?
1) Dementia
2) Dysphagia
3) Muscle cramps
4) Neck weakness
5) Optic atrophy
56- A 35-year-old man has wrist drop of his right hand. Examination reveals a small area of sensory loss on the dorsum of the hand. Which of the following nerves is likely to be involved?
1) Median nerve
2) Ulnar nerve
3) Long thoracic nerve
4) Radial nerve
5) T1 nerve root
57- A 92-year-old man was admitted in a confused state. He has a history of immobility due to severe lower back pain. He had been losing weight for three months and had complains of weakness, urinary frequency, thirst, poor urinary stream and constipation. Lumbar spine Xrays show severe osteopenia and collapse of the body of the vertebra at L3.
Investigations show:
haemoglobin 9.6 g/dl
sodium 144 mmol/l
potassium 3.9
urea 10.4
creatinine 120
glucose 8
dip stick urine blood ++, protein +
What is the most important immediate investigation?
1) Chest X-ray
2) MSU
3) prostate specific antigen
4) serum calcium
5) serum protein electrophoresis
58- A 25-year-old old woman presents with 2 hrs of a unilateral temporal headache increasing in severity. The Pain is of a throbbing character and is exacerbated by light. There are no abnormal signs on examination. What is the diagnosis?
1) Acute Subarachnoid haemorrhage.
2) Cluster headache.
3) Intracranial Tumour.
4) Migraine.
5) Tension headaches.
59- 50-year-old old man is admitted to hospital unconsious, and smelling of alcohol. One hour after admission, he becomes suddenly sweaty with a regular tachycardia of 110 bpm and a BP of 100/50. What is the diagnosis?
1) Alcohol withdrawal.
2) Hepatic encephalopathy.
3) Hypoglycaemia.
4) Subdural haematoma.
5) Wernicke's encephalopathy.
60- A 70-year-old man presents with weight loss, lower limb weakness and dry mouth. He has been a heavy smoker. On examination, he looks cachectic; he has proximal lower limb weakness, areflexia (reflexes normalise with repetitive muscle contraction). There is no wasting or fasciculations. Sensory examination is normal. Which of the following blood test is the most likely to confirm the diagnosis?
1) Acetylcholine receptors
2) Voltage gated calcium channels antibodies
3) Anti GM1 antibody
4) Antinuclear antibody
5) Anti Ro/La antibodies
1) Acalculia
2) Astereogenesis
3) Constructional apraxia
4) Cortical blindness
5) Visuospatial neglect
47- A 17-year-old man has been diagnosed with schizophrenia 4 weeks ago. He was started on haloperidol. Two weeks later he was found confused and drowsy. On examination he was pyrexial (40.7 C), rigid with blood pressure of 200/100. Which of the following treatment will you initiate?
1) phenytoin
2) diazepam
3) cefuroxime
4) acyclovir
5) dantrolene
48- A 50 year-old male epileptic presents with paraesthesia of hands and feet. He also has unsteadiness when walking. On examination he has Dupytren's contracture in his left hand, a peripheral sensory neuropathy and palpable lymph nodes in his neck and axillae.
Which of the following drugs is the most likely cause of these features?
1) Carbamazepine.
2) Clonazepam
3) Lamotrigine.
4) Phenytoin.
5) Sodium valproate.
49- An 80-year-old woman has a three month history of progressive numbness and unsteadiness of her gait. On examination, there is a mild spastic paraparesis, with brisk knee reflexes, ankle reflexes are present with reinforcement, extensor plantars, sensory loss in the legs with a sensory level at T10, impaired joint position sense in the toes, and loss of vibration sense below the iliac crests.
Investigations were as follows:-
haemoglobin 12.0 g/dl
MCV 99 fl
What is the most likely diagnosis?
1) anterior spinal artery occlusion
2) dorsal meningioma
3) multiple sclerosis
4) subacute combined degeneration of the cord
5) tabes dorsalis
50- A 16 year old girl presented with a three week history of headache and horizontal diplopia on far right lateral gaze. On two separate occasions she noted dimmed vision whilst bending forwards. Over the last year she had gained 12 kilograms in weight. On examination, her weight was 95 kg, and height 162cms. Neurological examination revealed bilateral papilloedema and a partial right sixth cranial nerve palsy. What is the most likely diagnosis?
1) Benign intracranial hypertension.
2) Multiple sclerosis.
3) Pituitary tumour
4) Superior sagittal vein thrombosis.
5) Thyroid eye disease.
51- Which of the following clinical manifestations suggests Guillain Barré Syndrome?
1) Weakness beginning in the arms
2) Asymmetrical involvement of distal muscles
3) Bulbar involvement in about 50% of cases
4) Brisk tendon reflexes
5) Normal CSF protein
52- In herpes simplex encephalitis which of the following statements is correct?
1) brain MRI is characteristically normal
2) temporal lobe involvement is common
3) fits are uncommon
4) cold sores or genital herpes are usually present
5) viral identification by PCR on cerebrospinal fluid is non-specific
53- A 25 year-old lady recently diagnosed with rheumatoid arthritis. She has developed weakness, double vision and tiredness. Examination reveals bilateral weakness of eye abduction, bilateral ptosis, slightly reduced proximal motor power in the limbs, normal reflexes and sensation. What is the diagnosis?
1) Chronic progressive external opthalmoplegia.
2) Guillain-Barre syndrome.
3) Multiple sclerosis.
4) Myasthenia gravis.
5) Polymyositis
54- A 63 year old male is admitted with acute onset unsteadiness of gait, dizziness and dysphagia. Examination revealed a right-sided Horner's syndrome, nystagmus, loss of pain and temperature sensation on the left side of the trunk and in the left arm and leg, and gait ataxia.
What is the most likely diagnosis?
1) leaking posterior communicating artery aneurysm
2) left sided acoustic neuroma
3) posterior inferior cerebellar artery occlusion
4) right sided pontine infarct
5) spontaneous left sided cerebellar haemorrhage
55- Which of the following features are not compatible with the diagnosis of motor neuron disease?
1) Dementia
2) Dysphagia
3) Muscle cramps
4) Neck weakness
5) Optic atrophy
56- A 35-year-old man has wrist drop of his right hand. Examination reveals a small area of sensory loss on the dorsum of the hand. Which of the following nerves is likely to be involved?
1) Median nerve
2) Ulnar nerve
3) Long thoracic nerve
4) Radial nerve
5) T1 nerve root
57- A 92-year-old man was admitted in a confused state. He has a history of immobility due to severe lower back pain. He had been losing weight for three months and had complains of weakness, urinary frequency, thirst, poor urinary stream and constipation. Lumbar spine Xrays show severe osteopenia and collapse of the body of the vertebra at L3.
Investigations show:
haemoglobin 9.6 g/dl
sodium 144 mmol/l
potassium 3.9
urea 10.4
creatinine 120
glucose 8
dip stick urine blood ++, protein +
What is the most important immediate investigation?
1) Chest X-ray
2) MSU
3) prostate specific antigen
4) serum calcium
5) serum protein electrophoresis
58- A 25-year-old old woman presents with 2 hrs of a unilateral temporal headache increasing in severity. The Pain is of a throbbing character and is exacerbated by light. There are no abnormal signs on examination. What is the diagnosis?
1) Acute Subarachnoid haemorrhage.
2) Cluster headache.
3) Intracranial Tumour.
4) Migraine.
5) Tension headaches.
59- 50-year-old old man is admitted to hospital unconsious, and smelling of alcohol. One hour after admission, he becomes suddenly sweaty with a regular tachycardia of 110 bpm and a BP of 100/50. What is the diagnosis?
1) Alcohol withdrawal.
2) Hepatic encephalopathy.
3) Hypoglycaemia.
4) Subdural haematoma.
5) Wernicke's encephalopathy.
60- A 70-year-old man presents with weight loss, lower limb weakness and dry mouth. He has been a heavy smoker. On examination, he looks cachectic; he has proximal lower limb weakness, areflexia (reflexes normalise with repetitive muscle contraction). There is no wasting or fasciculations. Sensory examination is normal. Which of the following blood test is the most likely to confirm the diagnosis?
1) Acetylcholine receptors
2) Voltage gated calcium channels antibodies
3) Anti GM1 antibody
4) Antinuclear antibody
5) Anti Ro/La antibodies
61- 54 year old female is admitted with progressive weakness following a trivial flu-like illness. Which of the following would exclude Guillain-Barre Syndrome as the diagnosis?
1) Autonomic dysfunction
2) Elevated protein on CSF examination
3) Evidence of muscle wasting
4) Ophthalmoplegia
5) Sensory level below D1
62- An 18 year old man presented with a history of a sudden onset of a frontal headache and photophobia. He had neck stiffness and a temperature of 38°C.
Which one of the following findings would suggest a diagnosis of subarachnoid haemorrhage rather than bacterial meningitis?
1) a blood neutrophil leucocytosis
2) a family history of polycystic renal disease
3) a fluctuating conscious level
4) a history of diabetes mellitus
5) a history of opiate abuse
63- A 45-year-old man has a history of progressive weakness for 5 weeks. He had particular difficulty getting out of the bath. On examination there was severe truncal and proximal limb weakness, without wasting or fasciculation. Tendon reflexes, plantar and sensation were all normal. The vital capacity was 1.8L. What is the most likely diagnosis?
1) cervical myelitis
2) Guillain-Barre syndrome
3) polio
4) polymyositis
5) syringiobulbia
64- Which is true regarding cerebral palsy?
1) The incidence is 2 per 100 live births.
2) Visual impairement occurs in 50%.
3) Hearing loss is present in 5%.
4) Epilepsy is present in 40%.
5) Learning impairment is present in 30%.
65- A right carotid artery stenosis could not account for:
1) Contralateral hemiplegia
2) Contralateral hemisensory loss
3) Drop attacks
4) Dysphasia
5) Right amaurosis fugax
66- Which of the following statements about the spinal cord is true?
1) A lesion of the left side of the spinal cord at C5 causes pyramidal weakness of the right leg
2) Centrally placed spinal cord lesions affect joint position sense before other modalities of sensation
3) Conus medullaris lesions characteristically cause mixed upper and lower motor neurone signs in the legs
4) The spinal cord ends at the lower border of the L3 vertebra
5) The spinothalamic tracts are supplied principally by the anterior spinal artery
67- A 50-year-old man presented with 18 months history of parasthesiae of his feet and hands. On examination there is numbness of glove and stocking distribution with generalised hyporeflexia. Nerve conduction studies revealed demyelinative sensory polyneuropathy. Which of the following conditions is the most likely diagnosis?
1) Alcohol abuse
2) Diabetes
3) Chronic inflammatory demyelinating polyneuropathy
4) Vasculitis
5) Vitamin B12 deficiency
68- Which of the following would be the result of a spinal lesion at the level of C8?
1) a reduced brachioradialis reflex
2) inability to abduct the shoulder
3) loss of sensation over the lateral aspect of the arm
4) winging of the scapula
5) weakness of finger flexion
69- Psychiatric illness rather than an organic brain disorder is suggested by:
1) Onset for the first time at the age of 55 years
2) A family history of major psychiatric illness
3) Impaired short term memory
4) No previous history of psychiatric illness
5) Clouding of conciousness
70- A 27 year-old male presents with 3 months of difficulty walking. Examination reveals motor weakness of left leg in a pyramidal distribution with increase in tone. Impaired pinprick sensation of right leg extending into the groin. What is the cause of these signs?
1) A central cauda equina lesion.
2) A cervical spinal cord lesion.
3) A foramen magnum lesion.
4) A left sided thoracic spinal cord lesion.
5) Bilateral cerebral hemisphere lesions.
71- Which of the following relate to Dopa-decarboxylase inhibitors?
1) enhance the effect of levodopa on the substantia nigra
2) reduce the extracerebral complications of L-dopa therapy
3) have anticholinergic activity
4) should not be given in combination with dopamine agonists
5) prevent L-dopa associated dyskinesias
72- Which of the following associations of muscles and nerve supply are NOT true:
1) Triceps and C7
2) Deltoid and C5
3) Gastroenemius and S1
4) Quadriceps and L3
5) Long flexors of fingers and C6
73- Which of the following would be expected following distal occlusion of the posterior cerebral artery?
1) cerebellar ataxia
2) contralateral hemiplegia
3) dysarthria
4) homonymous hemianopia
5) palatal palsy
74- A young teenager presents with fever and headache. He has received oral Amoxycillin for 3 days. Which of the following CSF findings would exclude a partially treated meningitis?
1) Negative gram stain
2) A CSF glucose of 45% of blood glucose
3) A white cell count of 50
4) A negative CSF culture
5) Negative Kernig's Sign
75- A 52 year old man has a slurring of his speech. Examination reveals bilateral partial ptosis and frontal balding, and difficulty releasing his grip after shaking hands. What is the most likely diagnosis?
1) myasthenia gravis
2) Eaton-Lambert syndrome
3) Myotonia dystrophica
4) Duchenne muscular dystrophy
5) Myotonia congenita
1) Autonomic dysfunction
2) Elevated protein on CSF examination
3) Evidence of muscle wasting
4) Ophthalmoplegia
5) Sensory level below D1
62- An 18 year old man presented with a history of a sudden onset of a frontal headache and photophobia. He had neck stiffness and a temperature of 38°C.
Which one of the following findings would suggest a diagnosis of subarachnoid haemorrhage rather than bacterial meningitis?
1) a blood neutrophil leucocytosis
2) a family history of polycystic renal disease
3) a fluctuating conscious level
4) a history of diabetes mellitus
5) a history of opiate abuse
63- A 45-year-old man has a history of progressive weakness for 5 weeks. He had particular difficulty getting out of the bath. On examination there was severe truncal and proximal limb weakness, without wasting or fasciculation. Tendon reflexes, plantar and sensation were all normal. The vital capacity was 1.8L. What is the most likely diagnosis?
1) cervical myelitis
2) Guillain-Barre syndrome
3) polio
4) polymyositis
5) syringiobulbia
64- Which is true regarding cerebral palsy?
1) The incidence is 2 per 100 live births.
2) Visual impairement occurs in 50%.
3) Hearing loss is present in 5%.
4) Epilepsy is present in 40%.
5) Learning impairment is present in 30%.
65- A right carotid artery stenosis could not account for:
1) Contralateral hemiplegia
2) Contralateral hemisensory loss
3) Drop attacks
4) Dysphasia
5) Right amaurosis fugax
66- Which of the following statements about the spinal cord is true?
1) A lesion of the left side of the spinal cord at C5 causes pyramidal weakness of the right leg
2) Centrally placed spinal cord lesions affect joint position sense before other modalities of sensation
3) Conus medullaris lesions characteristically cause mixed upper and lower motor neurone signs in the legs
4) The spinal cord ends at the lower border of the L3 vertebra
5) The spinothalamic tracts are supplied principally by the anterior spinal artery
67- A 50-year-old man presented with 18 months history of parasthesiae of his feet and hands. On examination there is numbness of glove and stocking distribution with generalised hyporeflexia. Nerve conduction studies revealed demyelinative sensory polyneuropathy. Which of the following conditions is the most likely diagnosis?
1) Alcohol abuse
2) Diabetes
3) Chronic inflammatory demyelinating polyneuropathy
4) Vasculitis
5) Vitamin B12 deficiency
68- Which of the following would be the result of a spinal lesion at the level of C8?
1) a reduced brachioradialis reflex
2) inability to abduct the shoulder
3) loss of sensation over the lateral aspect of the arm
4) winging of the scapula
5) weakness of finger flexion
69- Psychiatric illness rather than an organic brain disorder is suggested by:
1) Onset for the first time at the age of 55 years
2) A family history of major psychiatric illness
3) Impaired short term memory
4) No previous history of psychiatric illness
5) Clouding of conciousness
70- A 27 year-old male presents with 3 months of difficulty walking. Examination reveals motor weakness of left leg in a pyramidal distribution with increase in tone. Impaired pinprick sensation of right leg extending into the groin. What is the cause of these signs?
1) A central cauda equina lesion.
2) A cervical spinal cord lesion.
3) A foramen magnum lesion.
4) A left sided thoracic spinal cord lesion.
5) Bilateral cerebral hemisphere lesions.
71- Which of the following relate to Dopa-decarboxylase inhibitors?
1) enhance the effect of levodopa on the substantia nigra
2) reduce the extracerebral complications of L-dopa therapy
3) have anticholinergic activity
4) should not be given in combination with dopamine agonists
5) prevent L-dopa associated dyskinesias
72- Which of the following associations of muscles and nerve supply are NOT true:
1) Triceps and C7
2) Deltoid and C5
3) Gastroenemius and S1
4) Quadriceps and L3
5) Long flexors of fingers and C6
73- Which of the following would be expected following distal occlusion of the posterior cerebral artery?
1) cerebellar ataxia
2) contralateral hemiplegia
3) dysarthria
4) homonymous hemianopia
5) palatal palsy
74- A young teenager presents with fever and headache. He has received oral Amoxycillin for 3 days. Which of the following CSF findings would exclude a partially treated meningitis?
1) Negative gram stain
2) A CSF glucose of 45% of blood glucose
3) A white cell count of 50
4) A negative CSF culture
5) Negative Kernig's Sign
75- A 52 year old man has a slurring of his speech. Examination reveals bilateral partial ptosis and frontal balding, and difficulty releasing his grip after shaking hands. What is the most likely diagnosis?
1) myasthenia gravis
2) Eaton-Lambert syndrome
3) Myotonia dystrophica
4) Duchenne muscular dystrophy
5) Myotonia congenita
76- A 43-year-old woman develops a progressive, ascending motor weakness over several days. She is hospitalized and requires intubation with mechanical ventilation. She is afebrile. A lumbar puncture is performed with normal opening pressure and yields clear, colorless CSF with normal glucose, increased protein, and cell count of 5/microliter, all lymphocytes. She gradually recovers over the next month. Which of the following conditions most likely preceded the onset of her illness?
1) Ketoacidosis
2) Staphylococcus aureus septicemia
3) Systemic lupus erythematosus
4) Viral pneumonia
5) Vitamin B12 deficiency
77- A 19-year-old woman presents to the clinic having had 5 blackouts over the last year, all while she is standing up. She gets warnings of blurred vision, nausea, feeling hot. She had been witnessed twice to have jerking of all limbs while she is unconscious. The attacks last 30-60 seconds. She recovers quickly after the attacks. She has never bitten her tongue or sustained any injuries. Physical examination and an ECG are normal. Her grandmother and sister suffer from epilepsy. Which of the following investigations is the most appropriate?
1) EEG
2) 24 hour ECG recording
3) CT brain
4) ECHO
5) Tilt table test
78- A 36 year-old man has a 3 month history of pain in feet and lower legs. He was diagnosed as having diabetes at age 14 and treated with insulin. He is a cannabis smoker and drinks 30 units of alcohol per week. On examination he has impaired pain and temperature sensation in feet and lower legs, normal joint position and vibration sense. His reflexes are normal. What is the diagnosis?
1) Alcoholic polyneuropathy.
2) Chronic inflammatory demyelinating polyneuropathy (CIDP)
3) Diabetic polyneuropathy.
4) Syringomyelia.
5) Vitamin B12 deficiency.
79- A lesion of the parietal lobe causes:
1) Bitemporal hemianopia
2) Homonymous inferior quadrantanopia
3) Perseveration
4) Primitive reflexes
5) Wernike's (receptive) aphasia
80- The following are recognized features of Pancoast's tumour except:
1) ipsilateral Horner's syndrome
2) wasting of the dorsal interossei
3) pain in the arm radiating to the fourth and fifth fingers
4) erosion of the first rib
5) weakness of abduction at the shoulder
81- Causes of a small pupil include:
1) Carbon Monoxide Poisoning
2) Ethylene Glycol Poisoning
3) Holme's Adie pupil
4) Pontine haemorrhage
5) Third Nerve Palsy
82- A 70-year-old female patient presents with 2 months history of apathy, withdrawal, urinary and faecal incontinence and anosmia. The most likely anatomical site of the neurological lesion is at the:
1) frontal lobe
2) parietal lobe
3) temporal lobe
4) occipital lobe
5) internal capsule
83- A 21 year old man recovered from the immediate effects of a head injury sustained in a motor cycle accident three months previously. Which one of the following is the most likely delayed consequence of severe traumatic brain injury?
1) Episodic hypersomnia
2) Multiple obsessional symptoms
3) Outbursts of aggressive behaviour
4) Pathological jealousy
5) Persistent anxiety
84- A patient presented with a quadrantic hemianopia. Which of the following conditions is most likeley to cause such a presentation?
1) a lesion of the occipital cortex
2) a lesion of the optic chiasma
3) bilateral diabetic retinopathy
4) chloroquine poisoning
5) tobacco amblyopia
85- A 22 year old female presents with a month history of episodic, brief visual loss affecting the right eye. Over the last one year she had gained a considerable amount of weight. Examination reveals a BMI of 35, with bilateral optic disc swelling, worse on the right and small retinal haemorrhages on the right.
What is the most likely diagnosis?
1) benign intracranial hypertension
2) Craniopharyngioma
3) Graves' Ophthalmopathy
4) Optic neuritis
5) sagittal sinus thrombosis
86- Frontal lobe brain damage is associated with:
1) astereognosis
2) auditory agnosia
3) dressing apraxia
4) focal epileptic fits
5) perseveration
87- Chronic subdural haematoma in a 75-year-old man is NOT associated with the presence of:
1) hemiparesis
2) internuclear ophthalmoplegia
3) impaired cognitive function
4) fluctuating level of consciousness
5) bilateral papilloedema
88- A broad-based ataxic gait occurs characteristically with:
1) proximal myopathy
2) basal ganglia lesion
3) right-sided cerebral infarction
4) phenytoin toxicity
5) cerebellar vermis lesion
89- Which ONE of the following is associated with Parkinsonian features?
1) Chronic carbon dioxide retention
2) Kernicterus
3) Lead poisoning
4) Mercury poisoning
5) Wilson's disease
90- A 30-year-old female presents to the eye clinic with an acute history of pain and blurring in the right eye. Examination reveals a visual acuity of 6/36 in the right eye but 6/6 in the left eye, a central scotoma in the right eye, with a right swollen optic disc.
What is the most likely diagnosis?
1) Compression of the optic nerve
2) Cavernous sinus thrombosis
3) Glaucoma
4) Optic neuritis
5) Retinal vein occlusion
1) Ketoacidosis
2) Staphylococcus aureus septicemia
3) Systemic lupus erythematosus
4) Viral pneumonia
5) Vitamin B12 deficiency
77- A 19-year-old woman presents to the clinic having had 5 blackouts over the last year, all while she is standing up. She gets warnings of blurred vision, nausea, feeling hot. She had been witnessed twice to have jerking of all limbs while she is unconscious. The attacks last 30-60 seconds. She recovers quickly after the attacks. She has never bitten her tongue or sustained any injuries. Physical examination and an ECG are normal. Her grandmother and sister suffer from epilepsy. Which of the following investigations is the most appropriate?
1) EEG
2) 24 hour ECG recording
3) CT brain
4) ECHO
5) Tilt table test
78- A 36 year-old man has a 3 month history of pain in feet and lower legs. He was diagnosed as having diabetes at age 14 and treated with insulin. He is a cannabis smoker and drinks 30 units of alcohol per week. On examination he has impaired pain and temperature sensation in feet and lower legs, normal joint position and vibration sense. His reflexes are normal. What is the diagnosis?
1) Alcoholic polyneuropathy.
2) Chronic inflammatory demyelinating polyneuropathy (CIDP)
3) Diabetic polyneuropathy.
4) Syringomyelia.
5) Vitamin B12 deficiency.
79- A lesion of the parietal lobe causes:
1) Bitemporal hemianopia
2) Homonymous inferior quadrantanopia
3) Perseveration
4) Primitive reflexes
5) Wernike's (receptive) aphasia
80- The following are recognized features of Pancoast's tumour except:
1) ipsilateral Horner's syndrome
2) wasting of the dorsal interossei
3) pain in the arm radiating to the fourth and fifth fingers
4) erosion of the first rib
5) weakness of abduction at the shoulder
81- Causes of a small pupil include:
1) Carbon Monoxide Poisoning
2) Ethylene Glycol Poisoning
3) Holme's Adie pupil
4) Pontine haemorrhage
5) Third Nerve Palsy
82- A 70-year-old female patient presents with 2 months history of apathy, withdrawal, urinary and faecal incontinence and anosmia. The most likely anatomical site of the neurological lesion is at the:
1) frontal lobe
2) parietal lobe
3) temporal lobe
4) occipital lobe
5) internal capsule
83- A 21 year old man recovered from the immediate effects of a head injury sustained in a motor cycle accident three months previously. Which one of the following is the most likely delayed consequence of severe traumatic brain injury?
1) Episodic hypersomnia
2) Multiple obsessional symptoms
3) Outbursts of aggressive behaviour
4) Pathological jealousy
5) Persistent anxiety
84- A patient presented with a quadrantic hemianopia. Which of the following conditions is most likeley to cause such a presentation?
1) a lesion of the occipital cortex
2) a lesion of the optic chiasma
3) bilateral diabetic retinopathy
4) chloroquine poisoning
5) tobacco amblyopia
85- A 22 year old female presents with a month history of episodic, brief visual loss affecting the right eye. Over the last one year she had gained a considerable amount of weight. Examination reveals a BMI of 35, with bilateral optic disc swelling, worse on the right and small retinal haemorrhages on the right.
What is the most likely diagnosis?
1) benign intracranial hypertension
2) Craniopharyngioma
3) Graves' Ophthalmopathy
4) Optic neuritis
5) sagittal sinus thrombosis
86- Frontal lobe brain damage is associated with:
1) astereognosis
2) auditory agnosia
3) dressing apraxia
4) focal epileptic fits
5) perseveration
87- Chronic subdural haematoma in a 75-year-old man is NOT associated with the presence of:
1) hemiparesis
2) internuclear ophthalmoplegia
3) impaired cognitive function
4) fluctuating level of consciousness
5) bilateral papilloedema
88- A broad-based ataxic gait occurs characteristically with:
1) proximal myopathy
2) basal ganglia lesion
3) right-sided cerebral infarction
4) phenytoin toxicity
5) cerebellar vermis lesion
89- Which ONE of the following is associated with Parkinsonian features?
1) Chronic carbon dioxide retention
2) Kernicterus
3) Lead poisoning
4) Mercury poisoning
5) Wilson's disease
90- A 30-year-old female presents to the eye clinic with an acute history of pain and blurring in the right eye. Examination reveals a visual acuity of 6/36 in the right eye but 6/6 in the left eye, a central scotoma in the right eye, with a right swollen optic disc.
What is the most likely diagnosis?
1) Compression of the optic nerve
2) Cavernous sinus thrombosis
3) Glaucoma
4) Optic neuritis
5) Retinal vein occlusion
91- A 47-year-old man presents with memory impairment worsening over 9 months. He has jerking movements of his limbs and biphasic high-amplitude sharp waves on EEG. Which diagnosis is most likely?
1) Alzheimer's disease
2) Creutzfeld-Jakob disease
3) Multi-infarct dementia
4) Normal Pressure Hydrocephalus
5) Pick's disease
92- A 72-year-old woman has a five year history of worsening mental functioning with trouble remembering things. She has no problems with movement. She is noted on an MRI scan of the brain to have symmetrically increased size of the lateral ventricles along with cerebral cortical atrophy in a mainly frontal and parietal distribution. A lumbar puncture reveals a normal opening pressure, and analysis of the clear, colorless cerebrospinal fluid reveals a glucose and protein which are in
normal ranges. Cell count on the CSF shows 3 WBCs (all lymphocytes) and 1 RBC. A fundoscopic examination is normal. Which of the following findings is most likely associated with her underlying disease process?
1) Increased numbers of Lewy bodies
2) Loss of Betz cells
3) Loss of gamma aminobutyric acid (GABA)
4) Perivascular mononuclear inflammation
5) Presence of the e4 allele of apolipoprotein E
93- A 60-year-old man was brought to casualty after a fall in his bathroom. Seen immediately by his family, he was already picking himself up from the floor and said he was not injured. His wife felt that he was transiently dazed. On examination, he was alert, and no abnormalities were noted. His past medical history included a history of hypertension for which he was taking bendrofluazide 2.5 mg daily. He was discharged without any further intervention. Two weeks later his wife brings the patient to see you because the dazed state has returned. Examination reveals a temperature of 36.7C, a pulse rate of 84 bpm regular, a blood pressure of 152/94 mm Hg. On questioning he is slightly slowed, being disoriented to time with some deficit in recent memory.
The patient moves slowly, but power is normal. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right with unclear plantar responses because of bilateral withdrawal.
Which of the following would you request?
1) 24-hour ambulatory electrocardiogram
2) CSF analysis
3) CT of the head
4) Electromyography and nerve conduction testing
5) EEG
94- Which of the following forms of encephalitis is caused by a neuroimmunological response?
1) Herpes simplex
2) Measles
3) HIV infection
4) Enteral viruses
5) Cytomegalovirus
95- A 60-year-old woman presents with a 24 hours history of headache and vomiting. She has been on steroids for temporal arteritis for the last 3 years. Examination demonstrates pyrexia, neck stiffness, photophobia, dysarthria, nystagmus and ataxia. CSF shows neutrophilic pleocytosis, low glucose, elevated protein. What is the most likely diagnosis?
1) Carcinomatosis meningitis
2) Cryptococcal meningitis
3) Listeria meningitis
4) Meningococcal meningitis
5) Tuberculus meningitis
96- In which of the following is mental retardation an expected finding?
1) Alkaptonuria
2) Cystinuria
3) Glycogen storage disease
4) Lactose intolerance
5) Maple syrup urine disease
97- Which of the following is correct regarding Herpes simplex encephalitis?
1) shows a peak incidence in the Autumn
2) is associated with a polymorphonuclear pleocytosis in the CSF
3) produces a diffuse, evenly distributed inflammation of cerebral tissues
4) produces a typical EEG pattern with lateralised periodic discharges at 2 Hz
5) should be treated with acyclovir as soon as the diagnosis is confirmed by urgent CSF viral antibody titres
98- A 73-year-old man presents with an abrupt onset of double vision and left leg weakness. Examination shows weakness of abduction of the right eye, right-sided facial weakness affecting upper and lower parts of the face. He also has a left hemiparesis. Where is the lesion?
1) left frontal lobe
2) left lateral medulla
3) right corpus striatum
4) right midbrain
5) right pons
99- Which of the following statements regarding hiccup is true?
1) Is caused by a tonic relaxation of the diaphragm.
2) May be caused by local irritation to the vagus nerve.
3) Can reliably be treated with theophylline.
4) May be caused by a posterior fossa tumour.
5) May be caused by a foreign body in the nose.
100- In considering the management of convulsions select the correct statement from the list below.
1) If the fit lasts longer than 5 minutes, then PR diazepam should be given.
2) Phenobarbitone is a useful therapy in school age children.
3) Paraldehyde is best given intramuscularly.
4) Hypoglycaemia should always be considered.
5) When associated with fever, antibiotics should always be given to cover the possibility of meningitis.
101- The action of noradrenaline released at sympathetic nerve endings is terminated by
1) enzymatic decarboxylation
2) enzymatic inactivation by catechol-O-methyl transferase
3) re-uptake of noradrenaline by the axonal terminals
4) oxidative deamination by monoamine oxidase
5) Removal by the circulating blood
102- A 65 year-old woman with 12 hour history of unsteady gait, sudden onset associated with vomiting and headache. Following this she had increasing drowsiness. What is the diagnosis?
1) Acute subdural haemorrhage
2) Cerebellar haemorrhage.
3) Frontal subdural empyema
4) Herpes simplex encephalitis.
5) Pituitary apoplexy.
103- A 18-year-old female presents with a 3 days history of progressive weakness and numbness of her legs, urinary retention and back pain 2 weeks following an upper respiratory infection. On examination there is spastic paraparesis, sensory level up to T5, extensor plantars. Examination of cranial nerves and upper limbs is normal. MRI of the spine is normal. The most likely diagnosis is:
1) Multiple sclerosis
2) Anterior spinal artery occlusion
3) Post-infectious transverse myelitis
4) Thoracic disc prolapse
5) Guillain Barre syndrome
104- A 40-year-old man with a long history of alcohol abuse is admitted with a subacute illness, comprising headache, fever, meningism and ataxia. MRI brain showed patchy high signal abnormality of the brain stem. CSF analysis showed polymphonuclear pleocytosis and low glucose. He had failed to improve after 3 days of intravenous cefotaxime treatment. The most likely diagnosis of the meningitis is:
1) Mycobacterium tuberculosis
2) Cryptococcus neoformans
3) Nocardia asteroides
4) Staphyloccus aureus
5) Listeria monocytogenes
105- A 27-year-old man presents with a two years history of intermittent tingling sensation involving his left side. It starts in his fingers and spreads in 10-20 seconds to affect the whole arm and leg on the same side. The attacks only last for one minute. The most likely diagnosis is:
1) Migraine with aura
2) Transient ischaemic attacks
3) Somatosensory seizures
4) Hyperventilation
5) Multiple sclerosis
1) Alzheimer's disease
2) Creutzfeld-Jakob disease
3) Multi-infarct dementia
4) Normal Pressure Hydrocephalus
5) Pick's disease
92- A 72-year-old woman has a five year history of worsening mental functioning with trouble remembering things. She has no problems with movement. She is noted on an MRI scan of the brain to have symmetrically increased size of the lateral ventricles along with cerebral cortical atrophy in a mainly frontal and parietal distribution. A lumbar puncture reveals a normal opening pressure, and analysis of the clear, colorless cerebrospinal fluid reveals a glucose and protein which are in
normal ranges. Cell count on the CSF shows 3 WBCs (all lymphocytes) and 1 RBC. A fundoscopic examination is normal. Which of the following findings is most likely associated with her underlying disease process?
1) Increased numbers of Lewy bodies
2) Loss of Betz cells
3) Loss of gamma aminobutyric acid (GABA)
4) Perivascular mononuclear inflammation
5) Presence of the e4 allele of apolipoprotein E
93- A 60-year-old man was brought to casualty after a fall in his bathroom. Seen immediately by his family, he was already picking himself up from the floor and said he was not injured. His wife felt that he was transiently dazed. On examination, he was alert, and no abnormalities were noted. His past medical history included a history of hypertension for which he was taking bendrofluazide 2.5 mg daily. He was discharged without any further intervention. Two weeks later his wife brings the patient to see you because the dazed state has returned. Examination reveals a temperature of 36.7C, a pulse rate of 84 bpm regular, a blood pressure of 152/94 mm Hg. On questioning he is slightly slowed, being disoriented to time with some deficit in recent memory.
The patient moves slowly, but power is normal. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right with unclear plantar responses because of bilateral withdrawal.
Which of the following would you request?
1) 24-hour ambulatory electrocardiogram
2) CSF analysis
3) CT of the head
4) Electromyography and nerve conduction testing
5) EEG
94- Which of the following forms of encephalitis is caused by a neuroimmunological response?
1) Herpes simplex
2) Measles
3) HIV infection
4) Enteral viruses
5) Cytomegalovirus
95- A 60-year-old woman presents with a 24 hours history of headache and vomiting. She has been on steroids for temporal arteritis for the last 3 years. Examination demonstrates pyrexia, neck stiffness, photophobia, dysarthria, nystagmus and ataxia. CSF shows neutrophilic pleocytosis, low glucose, elevated protein. What is the most likely diagnosis?
1) Carcinomatosis meningitis
2) Cryptococcal meningitis
3) Listeria meningitis
4) Meningococcal meningitis
5) Tuberculus meningitis
96- In which of the following is mental retardation an expected finding?
1) Alkaptonuria
2) Cystinuria
3) Glycogen storage disease
4) Lactose intolerance
5) Maple syrup urine disease
97- Which of the following is correct regarding Herpes simplex encephalitis?
1) shows a peak incidence in the Autumn
2) is associated with a polymorphonuclear pleocytosis in the CSF
3) produces a diffuse, evenly distributed inflammation of cerebral tissues
4) produces a typical EEG pattern with lateralised periodic discharges at 2 Hz
5) should be treated with acyclovir as soon as the diagnosis is confirmed by urgent CSF viral antibody titres
98- A 73-year-old man presents with an abrupt onset of double vision and left leg weakness. Examination shows weakness of abduction of the right eye, right-sided facial weakness affecting upper and lower parts of the face. He also has a left hemiparesis. Where is the lesion?
1) left frontal lobe
2) left lateral medulla
3) right corpus striatum
4) right midbrain
5) right pons
99- Which of the following statements regarding hiccup is true?
1) Is caused by a tonic relaxation of the diaphragm.
2) May be caused by local irritation to the vagus nerve.
3) Can reliably be treated with theophylline.
4) May be caused by a posterior fossa tumour.
5) May be caused by a foreign body in the nose.
100- In considering the management of convulsions select the correct statement from the list below.
1) If the fit lasts longer than 5 minutes, then PR diazepam should be given.
2) Phenobarbitone is a useful therapy in school age children.
3) Paraldehyde is best given intramuscularly.
4) Hypoglycaemia should always be considered.
5) When associated with fever, antibiotics should always be given to cover the possibility of meningitis.
101- The action of noradrenaline released at sympathetic nerve endings is terminated by
1) enzymatic decarboxylation
2) enzymatic inactivation by catechol-O-methyl transferase
3) re-uptake of noradrenaline by the axonal terminals
4) oxidative deamination by monoamine oxidase
5) Removal by the circulating blood
102- A 65 year-old woman with 12 hour history of unsteady gait, sudden onset associated with vomiting and headache. Following this she had increasing drowsiness. What is the diagnosis?
1) Acute subdural haemorrhage
2) Cerebellar haemorrhage.
3) Frontal subdural empyema
4) Herpes simplex encephalitis.
5) Pituitary apoplexy.
103- A 18-year-old female presents with a 3 days history of progressive weakness and numbness of her legs, urinary retention and back pain 2 weeks following an upper respiratory infection. On examination there is spastic paraparesis, sensory level up to T5, extensor plantars. Examination of cranial nerves and upper limbs is normal. MRI of the spine is normal. The most likely diagnosis is:
1) Multiple sclerosis
2) Anterior spinal artery occlusion
3) Post-infectious transverse myelitis
4) Thoracic disc prolapse
5) Guillain Barre syndrome
104- A 40-year-old man with a long history of alcohol abuse is admitted with a subacute illness, comprising headache, fever, meningism and ataxia. MRI brain showed patchy high signal abnormality of the brain stem. CSF analysis showed polymphonuclear pleocytosis and low glucose. He had failed to improve after 3 days of intravenous cefotaxime treatment. The most likely diagnosis of the meningitis is:
1) Mycobacterium tuberculosis
2) Cryptococcus neoformans
3) Nocardia asteroides
4) Staphyloccus aureus
5) Listeria monocytogenes
105- A 27-year-old man presents with a two years history of intermittent tingling sensation involving his left side. It starts in his fingers and spreads in 10-20 seconds to affect the whole arm and leg on the same side. The attacks only last for one minute. The most likely diagnosis is:
1) Migraine with aura
2) Transient ischaemic attacks
3) Somatosensory seizures
4) Hyperventilation
5) Multiple sclerosis
106- A 24-year-old man presents with a headache that has been present for nine months. He has headache almost every day, mainly frontal, sometimes with nausea. Current medication includes paracetamol, brufen and codeine with only transient relief of symptoms. He has a history of depression. Examination was normal.
What is the most likely diagnosis?
1) analgesic misuse headache
2) cluster headache
3) frontal brain tumour
4) headache due to depression
5) migraine
107- A 60-year-old man awakens with painless loss of vision of his left eye. Three years earlier he had suffered a similar episode involving the right eye. Visual loss in that eye has been stationary. He does not complain of any systemic symptoms. What is the most likely diagnosis?
1) Optic neuritis
2) Nonarteritic ischaemic optic neuropathy
3) Arteritic ischaemic optic neuropathy
4) Acute angle-closure glaucoma
5) Compressive optic neuropathy
108- A 67-year-old man has drunk 8 units of alcohol a day for most of his adult life. He has worsening symptoms of poor memory, a wide-based gait and urinary incontinence for ten months. What is the most likely diagnosis?
1) HIV encephalitis
2) meningovascular syphilis
3) normal pressure hydrocephalus
4) syringomyelia
5) Wernicke-Korsakoff syndrome
109- A 40 year old male is diagnosed with Dystrophia myotonica. Which one of the following features would be expected in this patient?
1) Autosomal recessive inheritance
2) Cataracts
3) Fasiculations would predominate
4) Progressive external ophthalmoplegia
5) Preserved tendon reflexes despite muscle wasting
110- A 40-year-old man presents with 2 years history of intermittent strictly unilateral headaches. The pain is excruciating severe. It is located around the orbital region. The headache usually lasts 45-60 minutes. It usually appears early hours in the morning. There is associated ptosis and lacrimation on the side of the headache. The most likely diagnosis is:
1) Cluster headaches
2) Migraine
3) Tension type headache
4) Giant cell arteritis
5) Trigeminal neuralgia
111- A 50 year old female presents with a 4 month history of progressive distal sensory loss and weakness. On examination positive neurological findings include moderate proximal and distal weakness of arms and legs, glove and stocking sensory loss and areflexia. Planter responses were mute. The following conditions could give a similar picture:-
1) Guillian-Barre syndrome
2) Chronic inflammatory demyelinating neuropathy(CIDP)
3) Cervical spondylosis
4) Hereditary motor and sensory neuropathy(HMSN)
5) Myasthenia Gravis
112- Which one of the following would support a diagnosis of subacute combined degeneration of the cord rather than multiple sclerosis?
1) absent ankle jerks
2) autonomic symptoms
3) cerebellar signs
4) extensor plantars
5) visual problems
113- A 65-year-old woman has a one month history of malaise, weight loss, right sided pain around the eye and headaches. She has also noticed intermittent diplopia.
Five years previously she had a mastectomy for carcinoma of the breast. On examination, temperature was 37.5°C, there was tenderness of the scalp on the right forehead and temple, and some minor weakness of abduction of the right eye. ESR 55 mm/hour.
What is the most likely diagnosis?
1) thyroid eye disease
2) frontal sinusitis
3) giant cell arteritis
4) meningeal metastastatic disease
5) posterior communicating artery aneurysm
114- A sixty year old male presents with a six month history of a gradually increasing burning sensation in his feet. Examination revealed normal cranial nerves and higher mental function. Normal bulk, tone, power, light touch and pinprick sensation, co-ordination and reflexes in upper and lower limbs. The clinical findings are consistent with:-
1) Large fibre sensory neuropathy
2) Small fibre sensory neuropathy
3) Diabetic Amyotrophy
4) Motor neurone disease
5) Sjogrens syndrome
115-Which of the following anatomical considerations is correct:
1) optic chiasm lesions characteristically produce a bitemporal hemianopia
2) central scotoma occurs early in papilloedema
3) in cortical blindness pupillary reactions are abnormal
4) optic tract lesions produce an ipsilateral homonymous hemianopia
5) opticokinetic nystagmus is found with bilateral infarction of the parieto-occipital lobes
116- A 62 year old male is noted to have a broad-based ataxic gait.This is characteristic of which of the following?
1) A basal ganglia lesion
2) Cerebellar vermis lesion
3) Osteomalacia
4) phenytoin toxicity
5) Right-sided cerebral infarction
117- A lesion of the facial nerve in the internal auditory meatus will NOT affect
1) taste
2) sweating over the cheek
3) lacrimation
4) hearing
5) blinking
118- Which of the following is a form of generalised seizure?
1) Aversive seizures
2) Epilepsia partialis continua
3) Automatisms
4) Lennox Gastaut Syndrome
5) Benign rolandic epilepsy
119- A 21-year-old female presented with a sudden onset of left sided head and neck pain. 24 hours later she presents with sudden onset of right hemiparesis, facial weakness and homonymous hemianopia and left horner's syndrome. A CT brain showed a left middle cerebral artery territory infarction. The most likely diagnosis is:
1) Cardiac embolism
2) Migraine
3) Left Carotid artery dissection
4) Antiphospholipid syndrome
5) Systemic vasculitis
120- A 25 year-old man presents with 24 hours blurred vision in left eye and mild frontal headache. He has a 10 year history of Diabetes Mellitus. Examination reveals a central scotoma. What is the diagnosis?
1) Central retinal artery occlusion.
2) Diabetic retinopathy.
3) Optic neuritis.
4) Pituitary tumour.
5) Migraine.
What is the most likely diagnosis?
1) analgesic misuse headache
2) cluster headache
3) frontal brain tumour
4) headache due to depression
5) migraine
107- A 60-year-old man awakens with painless loss of vision of his left eye. Three years earlier he had suffered a similar episode involving the right eye. Visual loss in that eye has been stationary. He does not complain of any systemic symptoms. What is the most likely diagnosis?
1) Optic neuritis
2) Nonarteritic ischaemic optic neuropathy
3) Arteritic ischaemic optic neuropathy
4) Acute angle-closure glaucoma
5) Compressive optic neuropathy
108- A 67-year-old man has drunk 8 units of alcohol a day for most of his adult life. He has worsening symptoms of poor memory, a wide-based gait and urinary incontinence for ten months. What is the most likely diagnosis?
1) HIV encephalitis
2) meningovascular syphilis
3) normal pressure hydrocephalus
4) syringomyelia
5) Wernicke-Korsakoff syndrome
109- A 40 year old male is diagnosed with Dystrophia myotonica. Which one of the following features would be expected in this patient?
1) Autosomal recessive inheritance
2) Cataracts
3) Fasiculations would predominate
4) Progressive external ophthalmoplegia
5) Preserved tendon reflexes despite muscle wasting
110- A 40-year-old man presents with 2 years history of intermittent strictly unilateral headaches. The pain is excruciating severe. It is located around the orbital region. The headache usually lasts 45-60 minutes. It usually appears early hours in the morning. There is associated ptosis and lacrimation on the side of the headache. The most likely diagnosis is:
1) Cluster headaches
2) Migraine
3) Tension type headache
4) Giant cell arteritis
5) Trigeminal neuralgia
111- A 50 year old female presents with a 4 month history of progressive distal sensory loss and weakness. On examination positive neurological findings include moderate proximal and distal weakness of arms and legs, glove and stocking sensory loss and areflexia. Planter responses were mute. The following conditions could give a similar picture:-
1) Guillian-Barre syndrome
2) Chronic inflammatory demyelinating neuropathy(CIDP)
3) Cervical spondylosis
4) Hereditary motor and sensory neuropathy(HMSN)
5) Myasthenia Gravis
112- Which one of the following would support a diagnosis of subacute combined degeneration of the cord rather than multiple sclerosis?
1) absent ankle jerks
2) autonomic symptoms
3) cerebellar signs
4) extensor plantars
5) visual problems
113- A 65-year-old woman has a one month history of malaise, weight loss, right sided pain around the eye and headaches. She has also noticed intermittent diplopia.
Five years previously she had a mastectomy for carcinoma of the breast. On examination, temperature was 37.5°C, there was tenderness of the scalp on the right forehead and temple, and some minor weakness of abduction of the right eye. ESR 55 mm/hour.
What is the most likely diagnosis?
1) thyroid eye disease
2) frontal sinusitis
3) giant cell arteritis
4) meningeal metastastatic disease
5) posterior communicating artery aneurysm
114- A sixty year old male presents with a six month history of a gradually increasing burning sensation in his feet. Examination revealed normal cranial nerves and higher mental function. Normal bulk, tone, power, light touch and pinprick sensation, co-ordination and reflexes in upper and lower limbs. The clinical findings are consistent with:-
1) Large fibre sensory neuropathy
2) Small fibre sensory neuropathy
3) Diabetic Amyotrophy
4) Motor neurone disease
5) Sjogrens syndrome
115-Which of the following anatomical considerations is correct:
1) optic chiasm lesions characteristically produce a bitemporal hemianopia
2) central scotoma occurs early in papilloedema
3) in cortical blindness pupillary reactions are abnormal
4) optic tract lesions produce an ipsilateral homonymous hemianopia
5) opticokinetic nystagmus is found with bilateral infarction of the parieto-occipital lobes
116- A 62 year old male is noted to have a broad-based ataxic gait.This is characteristic of which of the following?
1) A basal ganglia lesion
2) Cerebellar vermis lesion
3) Osteomalacia
4) phenytoin toxicity
5) Right-sided cerebral infarction
117- A lesion of the facial nerve in the internal auditory meatus will NOT affect
1) taste
2) sweating over the cheek
3) lacrimation
4) hearing
5) blinking
118- Which of the following is a form of generalised seizure?
1) Aversive seizures
2) Epilepsia partialis continua
3) Automatisms
4) Lennox Gastaut Syndrome
5) Benign rolandic epilepsy
119- A 21-year-old female presented with a sudden onset of left sided head and neck pain. 24 hours later she presents with sudden onset of right hemiparesis, facial weakness and homonymous hemianopia and left horner's syndrome. A CT brain showed a left middle cerebral artery territory infarction. The most likely diagnosis is:
1) Cardiac embolism
2) Migraine
3) Left Carotid artery dissection
4) Antiphospholipid syndrome
5) Systemic vasculitis
120- A 25 year-old man presents with 24 hours blurred vision in left eye and mild frontal headache. He has a 10 year history of Diabetes Mellitus. Examination reveals a central scotoma. What is the diagnosis?
1) Central retinal artery occlusion.
2) Diabetic retinopathy.
3) Optic neuritis.
4) Pituitary tumour.
5) Migraine.
121- A 72-year-old lady has 4 months of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad-based, slow gait. Muscle tone is normal and both plantar reflexes are downgoing. What is the likely diagnosis?
1) Alzheimer's disease
2) Frontal lobe dementia
3) Mulit-infarct dementia
4) Normal-pressure hydrocephalus
5) Parkinson's disease
Answers-4
122- Baclofen
1) acts directly on skeletal muscle
2) causes rhabdomyolysis
3) reduces cerebral but not spinal spasticity
4) cause hallucinations when withdrawn
5) reduce Ca2+ release from sarcoplasmic reticulum
123- A 26-year-old previously healthy woman has the sudden onset of mental confusion. She has a seizure and is brought to the hospital. Her vital signs show blood pressure 100/60 mm Hg, temperature 37 C., pulse 89, and respirations 22. A lumbar puncture reveals a normal opening pressure, and clear, colorless cerebrospinal fluid is obtained with 1 RBC and 20 WBC's (all lymphocytes), with normal glucose and protein. An MRI scan reveals swelling of the right temporal lobe with hemorrhagic areas. Which of the following infectious agents is the most likely cause for these findings?
1) Haemophilus influenzae
2) Herpes simplex virus
3) Influenza virus
4) Mycobacterium tuberculosis
5) Neisseria meningitidis
124- Which of the following statements regarding central pontine myelinolysis is correct?
1) Consciousness is preserved characteristically.
2) MR imaging shows diagnostic features in the majority of patients.
3) The cause has been linked to over-rapid correction of hyponatraemic states.
4) The condition is confined to malnourished alcoholic patients.
5) The pathological changes are confined to the pons.
125- A 48 year old man presented with a two week history of recurrent severe right-sided peri-orbital headache, frequently nocturnal and occurring at least once daily, usually lasting an hour. He had noticed lacrimation from the right eye and blockage of the right nostril during the headache. At the time of the examination he was free from headache and there were no abnormal physical signs.
Which of the following is the most likely diagnosis?
1) cluster headache
2) intracranial aneurysm
3) orbital pseudotumour
4) right maxillary sinusitis
5) trigeminal neuralgia
126- Which of the following is a true of myasthenia gravis?
1) there is a strong association with anti-noradrenergic receptor antibodies
2) neurotransmitter released at the motor end plate is greatly reduced
3) repetitive stimulation of a motor nerve produces a reduction in the amplitude of the 5th response compared with the 1st in 98% of cases (electrodecremental test)
4) electrical recordings of single motor unit activity commonly reveal variation in the latency of the various mucle fibre responses (jitter)
5) subjective improvement in muscle strength following edrophonium is diagnostic of the condition
127- A 55-year-old man has progressive weakness of his hands over a period of 1 year. Examination reveals wasting of the muscles of the hands and forearms and fasciculation. There is hyper-reflexia of his lower limbs and upgoing plantars. Sensation is normal. Which of the following is the most likely diagnosis?
1) Alzheimer's disease
2) Motor Neurone Disease
3) Multiple Cerebral Infarcts
4) Multiple Sclerosis
5) Syringolmyelia
128- A 25-year-old female presented with 6 months history of depression, irritability and painful sensory symptoms in her legs. Over the last 4 weeks she presents a broad base ataxic gait. An MRI brain showed bilateral posterior thalamic nuclei (pulvinar region) high signals.
The most likely diagnosis is:
1) Sporadic CJD
2) New variant CJD
3) Wilson disease
4) Multiple system atrophy
5) Herpes simplex encephalitis
129- A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
1) Alzheimer type dementia
2) chronic sub-dural haematoma
3) Creutzfeldt-Jacob disease
4) depressive stupor
5) normal pressure hydrocephalus
130 -A lesion of the Frontal lobe causes:
1) Apraxia
2) Broca's (expressive) aphasia
3) Cortical blindness
4) Homonymous hemianopia
5) Visuospatial neglect
131- A 65-year-old man has a monotonous, slurred speech. He has an expressionless face and a festinant gait. There is also impairment of vertical gaze. What is the most likely underlying aetiology?
1) Shy-Drager syndrome
2) idiopathic
3) cerebrovascular disease
4) Wilson's disease
5) Steele-Richardson-Olszewski syndrome
132- Which of the following may cause a downbeat nystagmus?
1) Chiari type I malformation
2) Unilateral medial longitudinal fasciculus lesion
3) Central cerebellar lesion
4) Wernicke's encephalopathy
5) Aqueduct stenosis
133- A 35 year old female presents with headaches. Examination reveals papilloedema. Which of the following would make the diagnosis of benign intracranial hypertension unlikely?
1) Absence of retinal venous pulsations
2) Bilateral upgoing plantar responses
3) Normal ventricles on CT or MRI scan
4) Reduced visual acuity
5) VIth cranial nerve palsy
134-A teenage girl presents with Guillain-Barre syndrome. Her weakness continues to worsen after admission to hospital. Which of the following
should be used to monitor her?
1) arterial blood gases
2) chest expansion size
3) FEV1/FVC ratio
4) PEFR
5) vital capacity
135- A 60 year old man has Parkinson's disease. He is started on treatment with L-dopa and dopa decarboxylase inhibitor therapy. However he continues to have troublesome tremor. Which of the following drugs would be most likely to help?
1) Amantadine.
2) Benzexol.
3) Propranolol
4) Ropinirole
5) Selegiline
1) Alzheimer's disease
2) Frontal lobe dementia
3) Mulit-infarct dementia
4) Normal-pressure hydrocephalus
5) Parkinson's disease
Answers-4
122- Baclofen
1) acts directly on skeletal muscle
2) causes rhabdomyolysis
3) reduces cerebral but not spinal spasticity
4) cause hallucinations when withdrawn
5) reduce Ca2+ release from sarcoplasmic reticulum
123- A 26-year-old previously healthy woman has the sudden onset of mental confusion. She has a seizure and is brought to the hospital. Her vital signs show blood pressure 100/60 mm Hg, temperature 37 C., pulse 89, and respirations 22. A lumbar puncture reveals a normal opening pressure, and clear, colorless cerebrospinal fluid is obtained with 1 RBC and 20 WBC's (all lymphocytes), with normal glucose and protein. An MRI scan reveals swelling of the right temporal lobe with hemorrhagic areas. Which of the following infectious agents is the most likely cause for these findings?
1) Haemophilus influenzae
2) Herpes simplex virus
3) Influenza virus
4) Mycobacterium tuberculosis
5) Neisseria meningitidis
124- Which of the following statements regarding central pontine myelinolysis is correct?
1) Consciousness is preserved characteristically.
2) MR imaging shows diagnostic features in the majority of patients.
3) The cause has been linked to over-rapid correction of hyponatraemic states.
4) The condition is confined to malnourished alcoholic patients.
5) The pathological changes are confined to the pons.
125- A 48 year old man presented with a two week history of recurrent severe right-sided peri-orbital headache, frequently nocturnal and occurring at least once daily, usually lasting an hour. He had noticed lacrimation from the right eye and blockage of the right nostril during the headache. At the time of the examination he was free from headache and there were no abnormal physical signs.
Which of the following is the most likely diagnosis?
1) cluster headache
2) intracranial aneurysm
3) orbital pseudotumour
4) right maxillary sinusitis
5) trigeminal neuralgia
126- Which of the following is a true of myasthenia gravis?
1) there is a strong association with anti-noradrenergic receptor antibodies
2) neurotransmitter released at the motor end plate is greatly reduced
3) repetitive stimulation of a motor nerve produces a reduction in the amplitude of the 5th response compared with the 1st in 98% of cases (electrodecremental test)
4) electrical recordings of single motor unit activity commonly reveal variation in the latency of the various mucle fibre responses (jitter)
5) subjective improvement in muscle strength following edrophonium is diagnostic of the condition
127- A 55-year-old man has progressive weakness of his hands over a period of 1 year. Examination reveals wasting of the muscles of the hands and forearms and fasciculation. There is hyper-reflexia of his lower limbs and upgoing plantars. Sensation is normal. Which of the following is the most likely diagnosis?
1) Alzheimer's disease
2) Motor Neurone Disease
3) Multiple Cerebral Infarcts
4) Multiple Sclerosis
5) Syringolmyelia
128- A 25-year-old female presented with 6 months history of depression, irritability and painful sensory symptoms in her legs. Over the last 4 weeks she presents a broad base ataxic gait. An MRI brain showed bilateral posterior thalamic nuclei (pulvinar region) high signals.
The most likely diagnosis is:
1) Sporadic CJD
2) New variant CJD
3) Wilson disease
4) Multiple system atrophy
5) Herpes simplex encephalitis
129- A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
1) Alzheimer type dementia
2) chronic sub-dural haematoma
3) Creutzfeldt-Jacob disease
4) depressive stupor
5) normal pressure hydrocephalus
130 -A lesion of the Frontal lobe causes:
1) Apraxia
2) Broca's (expressive) aphasia
3) Cortical blindness
4) Homonymous hemianopia
5) Visuospatial neglect
131- A 65-year-old man has a monotonous, slurred speech. He has an expressionless face and a festinant gait. There is also impairment of vertical gaze. What is the most likely underlying aetiology?
1) Shy-Drager syndrome
2) idiopathic
3) cerebrovascular disease
4) Wilson's disease
5) Steele-Richardson-Olszewski syndrome
132- Which of the following may cause a downbeat nystagmus?
1) Chiari type I malformation
2) Unilateral medial longitudinal fasciculus lesion
3) Central cerebellar lesion
4) Wernicke's encephalopathy
5) Aqueduct stenosis
133- A 35 year old female presents with headaches. Examination reveals papilloedema. Which of the following would make the diagnosis of benign intracranial hypertension unlikely?
1) Absence of retinal venous pulsations
2) Bilateral upgoing plantar responses
3) Normal ventricles on CT or MRI scan
4) Reduced visual acuity
5) VIth cranial nerve palsy
134-A teenage girl presents with Guillain-Barre syndrome. Her weakness continues to worsen after admission to hospital. Which of the following
should be used to monitor her?
1) arterial blood gases
2) chest expansion size
3) FEV1/FVC ratio
4) PEFR
5) vital capacity
135- A 60 year old man has Parkinson's disease. He is started on treatment with L-dopa and dopa decarboxylase inhibitor therapy. However he continues to have troublesome tremor. Which of the following drugs would be most likely to help?
1) Amantadine.
2) Benzexol.
3) Propranolol
4) Ropinirole
5) Selegiline
136- Which of the following would be expected features of a LEFT Posterior cerebral artery occlusion :
1) a right homonymous hemianopia
2) internuclear ophthalmoplegia
3) Wernicke's aphasia
4) pure aphasia (i.e. without alexia)
5) decerebrate state
137- A 70-year-old woman has a history of dyspnoea and palpitations for six months. An ECG at that time showed atrial fibrillation. She was given digoxin, diuretics and aspirin. She now presents with two short-lived episodes of altered sensation in the left face, left arm and leg. There is poor coordination of the left hand. ECHO was normal as was a CT head scan.
What is the most appropriate next step in management?
1) anticoagulation
2) carotid endarterectomy
3) clopidogrel
4) corticosteroid treatment
5) no action
138- A patient presented with a quadrantic hemianopia. Which of the following conditions is most likeley to cause such a presentation?
1) a lesion of the occipital cortex
2) a lesion of the optic chiasma
3) bilateral diabetic retinopathy
4) chloroquine poisoning
5) tobacco amblyopia
139- A 57-year-old man develops deep venous thrombosis during a hospitalization for prostatectomy. He exhibits decreased mental status with right hemiplegia, and a CT scan of the head suggests an acute cerebral infarction in the distribution of the left middle cerebral artery. A chest X-ray reveals cardiac enlargement and prominence of the main pulmonary arteries that suggests pulmonary hypertension. His serum troponin I is <0.4 ng/mL. Which of the following lesions is most likely to
be present on echocardiography?
1) Coarctation of the aorta
2) Dextrocardia
3) Pulmonary stenosis
4) Tetralogy of Fallot
5) Ventricular septal defect
140- A 55-year-old woman has had worsening shortness of breath for several years. She now has to sleep sitting up on two pillows. She has difficulty swallowing. There is no history of chest pain. She is afebrile. Recently, she suffered a stroke with left hemiparesis. A chest X-ray reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for these findings?
1) Aortic coarctation
2) Cardiomyopathy
3) Essential hypertension
4) Left renal artery stenosis
5) Mitral valve stenosis
141- A 63 year old male is admitted with acute onset unsteadiness of gait, dizziness and dysphagia. Examination revealed a right-sided Horner's syndrome, nystagmus, loss of pain and temperature sensation on the left side of the trunk and in the left arm and leg, and gait ataxia.
What is the most likely diagnosis?
1) leaking posterior communicating artery aneurysm
2) left sided acoustic neuroma
3) posterior inferior cerebellar artery occlusion
4) right sided pontine infarct
5) spontaneous left sided cerebellar haemorrhage
142- Which of the following would be expected following distal occlusion of the posterior cerebral artery?
1) cerebellar ataxia
2) contralateral hemiplegia
3) dysarthria
4) homonymous hemianopia
5) palatal palsy
143- Which of the following would be expected features of a LEFT Posterior cerebral artery occlusion :
1) a right homonymous hemianopia
2) internuclear ophthalmoplegia
3) Wernicke's aphasia
4) pure aphasia (i.e. without alexia)
5) decerebrate state
144- Regarding pseudotumours cerebri (benign hypercranial hypertension) which is true?
1) A mildly increased CSF cell count is typical.
2) May be caused by prolonged steriod therapy.
3) Is occasionally associated with focal neurological signs.
4) Frequently presents with ataxia.
5) Is distinguished from hydrocephalus by the absence of suture separation.
145- Which of the following clinical manifestations suggests Guillain Barré Syndrome?
1) Weakness beginning in the arms
2) Asymmetrical involvement of distal muscles
3) Bulbar involvement in about 50% of cases
4) Brisk tendon reflexes
5) Normal CSF protein
146- A complete unilateral facial hemiparesis may be caused by which of the following?
1) An intracranial tumour
2) Birth injury
3) Cerebellar atrophy
4) Myasthenia gravis
5) Phenothiazine toxicity
147-A 65-year-old male presents with bilateral leg pain. There is no relevant past medical history, and no excess alcohol use. Both knee reflexes are reduced. Fasting glucose is 6.5 mmol/L. Which is the next most likely investigation to confirm the diagnosis?
1) B12 and folate
2) Chest X-ray
3) CSF examination
4) MRI spine
5) Oral glucose tolerance test
148-A 45-year-old man presents with headaches and low libido. He is found to be hypopituitary. The CT scan shows a pituitary tumour with suprasellar extension. Which of the following structures is likely to be compressed?
1) Abducens nerve
2) Hypothalamus
3) Occulomotor nerve
4) 3rd Ventricle
5) Optic nerve
Go to next Page: 1) a right homonymous hemianopia
2) internuclear ophthalmoplegia
3) Wernicke's aphasia
4) pure aphasia (i.e. without alexia)
5) decerebrate state
137- A 70-year-old woman has a history of dyspnoea and palpitations for six months. An ECG at that time showed atrial fibrillation. She was given digoxin, diuretics and aspirin. She now presents with two short-lived episodes of altered sensation in the left face, left arm and leg. There is poor coordination of the left hand. ECHO was normal as was a CT head scan.
What is the most appropriate next step in management?
1) anticoagulation
2) carotid endarterectomy
3) clopidogrel
4) corticosteroid treatment
5) no action
138- A patient presented with a quadrantic hemianopia. Which of the following conditions is most likeley to cause such a presentation?
1) a lesion of the occipital cortex
2) a lesion of the optic chiasma
3) bilateral diabetic retinopathy
4) chloroquine poisoning
5) tobacco amblyopia
139- A 57-year-old man develops deep venous thrombosis during a hospitalization for prostatectomy. He exhibits decreased mental status with right hemiplegia, and a CT scan of the head suggests an acute cerebral infarction in the distribution of the left middle cerebral artery. A chest X-ray reveals cardiac enlargement and prominence of the main pulmonary arteries that suggests pulmonary hypertension. His serum troponin I is <0.4 ng/mL. Which of the following lesions is most likely to
be present on echocardiography?
1) Coarctation of the aorta
2) Dextrocardia
3) Pulmonary stenosis
4) Tetralogy of Fallot
5) Ventricular septal defect
140- A 55-year-old woman has had worsening shortness of breath for several years. She now has to sleep sitting up on two pillows. She has difficulty swallowing. There is no history of chest pain. She is afebrile. Recently, she suffered a stroke with left hemiparesis. A chest X-ray reveals a near-normal left ventricular size with a prominent left atrial border. Which of the following conditions is most likely to account for these findings?
1) Aortic coarctation
2) Cardiomyopathy
3) Essential hypertension
4) Left renal artery stenosis
5) Mitral valve stenosis
141- A 63 year old male is admitted with acute onset unsteadiness of gait, dizziness and dysphagia. Examination revealed a right-sided Horner's syndrome, nystagmus, loss of pain and temperature sensation on the left side of the trunk and in the left arm and leg, and gait ataxia.
What is the most likely diagnosis?
1) leaking posterior communicating artery aneurysm
2) left sided acoustic neuroma
3) posterior inferior cerebellar artery occlusion
4) right sided pontine infarct
5) spontaneous left sided cerebellar haemorrhage
142- Which of the following would be expected following distal occlusion of the posterior cerebral artery?
1) cerebellar ataxia
2) contralateral hemiplegia
3) dysarthria
4) homonymous hemianopia
5) palatal palsy
143- Which of the following would be expected features of a LEFT Posterior cerebral artery occlusion :
1) a right homonymous hemianopia
2) internuclear ophthalmoplegia
3) Wernicke's aphasia
4) pure aphasia (i.e. without alexia)
5) decerebrate state
144- Regarding pseudotumours cerebri (benign hypercranial hypertension) which is true?
1) A mildly increased CSF cell count is typical.
2) May be caused by prolonged steriod therapy.
3) Is occasionally associated with focal neurological signs.
4) Frequently presents with ataxia.
5) Is distinguished from hydrocephalus by the absence of suture separation.
145- Which of the following clinical manifestations suggests Guillain Barré Syndrome?
1) Weakness beginning in the arms
2) Asymmetrical involvement of distal muscles
3) Bulbar involvement in about 50% of cases
4) Brisk tendon reflexes
5) Normal CSF protein
146- A complete unilateral facial hemiparesis may be caused by which of the following?
1) An intracranial tumour
2) Birth injury
3) Cerebellar atrophy
4) Myasthenia gravis
5) Phenothiazine toxicity
147-A 65-year-old male presents with bilateral leg pain. There is no relevant past medical history, and no excess alcohol use. Both knee reflexes are reduced. Fasting glucose is 6.5 mmol/L. Which is the next most likely investigation to confirm the diagnosis?
1) B12 and folate
2) Chest X-ray
3) CSF examination
4) MRI spine
5) Oral glucose tolerance test
148-A 45-year-old man presents with headaches and low libido. He is found to be hypopituitary. The CT scan shows a pituitary tumour with suprasellar extension. Which of the following structures is likely to be compressed?
1) Abducens nerve
2) Hypothalamus
3) Occulomotor nerve
4) 3rd Ventricle
5) Optic nerve
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