Copy of Neurology Module 2

An 84-year-old man comes to your clinic to be evaluated for a 5-year history of a gradually worsening gait and a 2-year history of cognitive impairment and urinary incontinence. Twelve years ago, he sustained a closed head injury that caused a mild traumatic subarachnoid hemorrhage and had lost consciousness for five hours.

His current medications include Zopiclone and multivitamins.

On physical examination, he is afebrile with stable observations. His BMI is 27.

The patient’s gait is slow and unsteady and is marked by small, shuffling steps.

His level of alertness, speech, posture, arm swing, and muscle tone are all normal, and he has no tremor.

He scores 24/30 on the Folstein Mini Mental State Examination, losing one point in the orientation portion for incorrectly stating today’s date, three points in the serial calculation portion, and two points in the recall portion.

Results of a complete blood count, a basic metabolic panel, serum vitamin B12 measurement, thyroid function tests, and a urinalysis are normal.

What is the most likely diagnosis?

A 65 year old man is assessed on the ward for weakness in his legs. He is an ex smoker and drinks 15 units of alcohol in a week. His wife mentions that he is confused.

On examination, his MMSE score is 20/30. He has an ataxic gait. There is bilateral pyramidal weakness and coordination is impaired.

Routine blood tests are normal. An MRI scan of the head shows diffuse white matter changes, more in the cerebellar region than the cerebrum.

Which of these tests would help most in confirming the diagnosis?

A 65 year old man of Māori descent has nystagmus looking to the left, ataxia and vertigo. He also has a left sided Horner’s syndrome. There is loss of pain and temperature on the left side of the face and a loss of pain and temperature on the right side of the trunk and limbs.

Which of the following is the diagnosis?

Which of the following feature is most suggestive of a cluster headachecompared to a migraine attack?

Lumbar puncture should be preceded by CT or MRI in all of the following subsets of patients suspected of having meningitis except those with:

A 27 year old lady has been referred from the ophthalmology clinic with bilateral papilloedema. She has a background of obesity with BMI of 35 and a previous renal calculi. She had been complaining of having blurred vision for several months associated with a chronic dull left sided headache so decided to see the optometrist as she thought she needed glasses. On visual testing, the left eye had a large blindspot and the optic discs were swollen bilaterally. Other cranial nerve and motor exam was unremarkable.

CT head was normal. A lumbar puncture demonstrated an opening pressure 31cm H2O and a closing pressure 16cm H2O. The CSF glucose, protein and chemistry were normal. MRI and MRV showed some narrowing of the dural venous sinuses but no thrombosis seen. The pituitary is unremarkable in appearance and no other significant abnormality was seen.

Based on the above clinical findings, which of the following treatment/intervention would be least helpful?

Which of the following mutation occurs in the Familial form of Amyotrophic Lateral Sclerosis(FALS)?

Which investigation is the most useful in making the diagnosis of motor neuron disease?

A 30 year old man presents with weakness of tongue and mouth muscles.

He also complains of increasing weakness of his limb muscles. He has been trying to have children with his partner but has been unsuccessful.

On examination, there is evidence of muscle wasting.fasciculations and gynaecomastia.

What is the most likely diagnosis?

In motor neuron disease, which of the following interventions are most likely to prolong survival?

What is the mechanism of action of Riluzole?

A patient who presents purely of lower motor neuron signs will likely to have?

A patient who presents purely of upper motor neuron signs will likely to have?

A patient who has upper and lower motor neuron signs and bulbar dysfunction but with normal sensation will likely to have?

All of the following are associated with poor survival in motor neuron disease except?

What is the most common cause of death in MND?

Which of the following drug increases the serum level of carbamazepine?

Which of the following anti-epileptic drug may cause osteoporosis?

Which of the following anti-epileptic drug has the most teratogenic effect in pregnancy?

Which of the following anti-epileptic drugs may cause visual field changes?

Which of the following anti-epileptic drug causes weight loss?

A patient is referred due to the development of a third nerve palsy associated with a headache. On examination meningism is present. Which one of the following diagnoses needs to be urgently excluded?

A 22 year old woman with a history of epilepsy decides to use an oral contraceptive pill to prevent pregnancy.

Which Anti-epileptic drug should she use?

Which of the following AED will most likely cause Steven Johnson Syndrome?

Which of the following drugs should be avoided in juvenile myoclonic epilepsy?

A 15 year old with a seizure disorder presents with ongoing seizure.Previously had tonic clonic seizure and period of absences after sleep deprivation.The physician have decided to start her on carbamazepine.Which of the following question should be elicited before commencing this drug?

Which of the following anti-convulsants is most likely to Increase the half life of lamotrigine?

The following treatments are useful in essential tremor except?

What is the most common symptom of excess levodopa?

What is the mechanism of action of amantadine?