100 SBA Questions

 

Single Best Answers

These are the initial 100 SBA questions, please try your best. Some of these questions maybe more or less advanced. I have included questions from my medical school finals (some Neurology). I will collate a bank of at least 250 questions. These are the first 100.

 

1. A young patient who was diagnosed with a right extradural haematoma. Which artery is ruptured in this pathology?

 

• Anterior Branch of the Middle Meningeal Artery
• Posterior Branch of the Middle Meningeal Artery
• Anterior Ethmoidal Artery
• Middle Cerebral Artery
• Anterior Communicating Artery

 

 

2. A 28-year-old female was diagnosed with a traumatic acute subdural haematoma. She presents having weakness ipsilateral to the subdural collection. What is the name of this phenomenon?

 

• Uncal herniation
• Sub-Falcine Herniation
• Kernohan’s Herniation
• Tonsillar Herniation
• Anxiety

 

 

3. A 37-year-old female was diagnosed with a traumatic acute subdural haematoma. She presented having contra-lateral leg weakness. What is the name of this phenomenon?

 

• Sub-Falcine Herniation
• Uncal Herniation
• Kernohan’s Herniation
• Anxiety
• Tonsillar Herniation

 

 

4. A 37-year-old male was accidentally hit on the head with a baseball bat in the changing room. He lost consciousness for 2 minutes, without a loss of postural tone. He remained well for 45 minutes, before collapsing again. What is the term often used to explain this phenomenon?

 

• Vaso-Vagal Syncope
• Lucid Interval
• Seizure
• Cardiac Syncope

 

 

5. A 66-year-old patient, presented with fluctuating in consciousness and confusion following multiple falls. She has a history of recurrent pulmonary embolisms and is on long-term anti-coagulation. What is the likely pathophysiology for this patients presentation

 

• Diffuse axonal injury
• Tearing of bridging veins with cerebral atrophy
• Ischaemia
• Frontal Contusions
• Sub-Arachnoid Haemorrhage

 

 

6. A 25-year-old patient was admitted into Resus into A+E following a car accident. He had a GCS of 5. A diagnosis of acute subdural was made. What features on the CT scan would most likely describe this pathology?

 

• Isodense with concave irregularity
• Hypodense with lenticular irregularity
• Hyperdense with concave irregularity
• Hyperdense with lenticular irregularity
• Hypodense with concave irregularity

 

 

7. Which of these is not a recognised post-operative complication of burr-hole evacuation of a chronic subdural haematoma

 

• Tension Pneumocephalus
• Seizure
• Recollection
• Subdural Empyema
• Hydrocephalus

 

 

8. Which cranial nerve is most likely to be compressed due to a sudden increase in raised intra-cranial pressure?

• 3^rd
• 4^th
• 5^th
• 6^th
• 7^th

 

 

9. The two recognised complications of Uncal herniation include:

• 3^rd nerve palsy with posterior cerebral artery compression
• 4^th nerve palsy with middle cerebral artery compression
• 6^th nerve palsy with posterior cerebral artery compression
• 3^rd nerve palsy with middle cerebral artery compression
• 3^rd nerve palsy with anterior cerebral artery compression

 

 

 

 

 

10. The best post-operative management to prevent recollection of subdural haematoma should include:

• Flat bed rest with a drain for 24 hours
• Elevated bed rest without a drain for 48 hours
• Flat bed rest with a drain for 48 hours
• Flat bed rest without a drain for 24 hours
• Flat bed rest without a drain for 48 hours

 

 

11. A 32 year old who was admitted onto the Neurosurgical Unit with a SAH was found to have a Sodium level of 120mmol/l. Her fluid status examination revealed dry mucous membranes, prolonged capillary refill, and a weak pulse. Her urine osmolality > 40mmol/l with a low serum osmolality. She takes Citalopram for depression. She has a PMH of hypothyroidism.

The most likely diagnosis is:

 

• Dehydration
• Cerebral Salt Wasting Syndrome
• Syndrome of Inappropriate Anti-Diuretic Hormone Secretion
• Medication Induced
• Hypothyroidism

 

 

12. A 65-year-old patient presents with double vision 10 days post surgical management. Fundoscopy reveals vitreous haemorrhage. What is the diagnosis?

 

• Duane Syndrome
• Brown’s Syndrome
• Terson’s syndrome
• Tolosa-Hunt Syndrome
• Post operative complication

 

 

13. A patient presents with central crushing chest pain radiating to the neck 2 days following admission from a Sub-Arachnoid Haemorrhage. The most likely complication is?

 

• Pericarditis
• Aortic dissection
• Muscular Chest Pain
• Sub-endocardial ischaemia
• Neurogenic Pulmonary Oedema

 

 

 

14.Which of the following IV Fluid preparations would not be routinely used in the management of Neurosurgical patients?

 

• Normal Saline 0.9%
• Hartmann’s Solution
• Geloplasma
• Volplex
• Dextrose

 

 

15.What is the length of time, Nimodipine should be prescribed for the prevention of cerebral vasospasm?

 

• 6 days
• 8 days
• 10 days
• 14 days
• 21 days

 

 

16. Which of these prognostic indicator scales determines the likelihood of cerebral vasospasm?

 

• World Federation Neurosurgeons Society Score (WFNS)
• ABCD2 score
• Hunt and Hess Grade
• Fisher
• CHADS2- VASC

 

 

17. An External Ventricular Drain for the management of hydrocephalus is inserted into which anatomical location in the brain?

 

• Keen’s Point
• Kocher’s Point
• Dandy’s Point
• Frazier’s Point
• No Point required

 

 

18. Which cranial nerve is most likely to be affected in a patient with hydrocephalus?

 

• 3^rd
• 4^th
• 6^th
• 7^th
• 8^th

 

 

19.A patient with painful third nerve palsy is commonly associated with which aneurysm?

 

(a) Posterior Communicating Artery

(b) Anterior Communicating Artery

(c) Posterior Cerebral Artery

(d) Basilar Artery

(e) Anterior Cerebral Artery

 

 

 

20. What is the most common cause of a SAH?

 

• Dural AV Fistula
• Aneurysm
• Iatrogenic
• Traumatic
• Cavernoma

 

 

21. A 34-year-old female presented with a sub-arachnoid haemorrhage. A CT (Angiography) revealed a ruptured MCA Aneurysm. The presence of blood in which anatomical landmark visible on a plain CT scan would indicate a ruptured MCA aneurysm?

 

• Anterior Hemispheric Fissure
• Falx Cerebri
• Sylvian Fissure
• Tentorium Cerebelli
• Falx cerebelli

 

 

22. A 35 year old gentlemen presents with sudden onset vomiting, photophobia and occipital headache. His BP 200/90, Pulse 86. Examination revealed an ejection systolic murmur without carotid radiation. Which of the following is most likely responsible for the murmur found upon examination.

 

• Aortic Stenosis
• Mitral Regurgitation
• Co-Arctation of the Aorta
• Mitral Stenosis
• Tricuspid Regurgitation

 

 

23. Which of the following statement best describes the CT scan shown below:

 

• Blood in the peri-mesencephalic region of the brain
• Blood within the basal cisterns only
• Blood within the Sylvian, anti-hemispheric fissure and basal cisterns
• Blood within the Sylvian, anti-hemispheric fissure and basal cisterns and early hydrocephalus
• No change on the CT scan

 

24. A 45-year-old gentleman is diagnosed with a ruptured anterior communicating artery aneurysm. His GCS was 11 with associated aphasia and weakness. His WFNS score is?

 

• 1
• 2
• 3
• 4
• 5

 

 

25. A 63-year-old gentlemen presents with left sided weakness and dysphasia 7 days post evacuation of a frontal haematoma with associated aneurysmal clipping. A CT Head excluded a re-bleed and a venous blood gas reveals a normal lactate. Which of the following treatments is essential in the management of this patient?

 

• Ward Based IV Fluid Therapy
• No treatment required
• Anti-Convulsant Therapy
• External Ventricular Drain
• Triple H Therapy

 

 

26. You see an 81-year-old lady in the A+E department who presents with a 3-week history of confusion. She attended a GP Practice who diagnosed her with a urinary tract infection, however her confusion has not resolved. She has a PMH of a mitral valve replacement. Her CT scan is shown below. You are asked to consent this patient. You deem she lacks capacity. What consent form is required?

 

 

• Consent form 1
• Consent form 2
• Consent form 3
• Consent form 4
• No consent required

 

 

27. A 25-year-old male presents into AE following a road traffic accident. His Trauma Series revealed a C3/C4 fracture, splenic laceration. He had a GCS of 7, with pupils equal and reactive. His observations: BP 90/50mmHg, Pulse 130mmHg. His CT scan revealed a traumatic sub-arachnoid haemorrhage. How would this patient’s sub-arachnoid be managed?

 

• Urgent Aneurysmal Clipping
• Endovascular Coiling
• Admission into Intensive Care Unit with monitoring of complications.
• Ward Based Management
• Admission into ITU with trauma team input, neuro-observations and ICP Boult insertion to monitor for raised ICP

 

 

28. A 16-year-old female presented with a typical history of a sub-arachnoid haemorrhage 3 days ago. Her CT scan was negative. A Lumber Puncture was was performed. Which of the following is the most specific finding on a LP to confirm a diagnosis of a SAH

 

• Red Blood Cells
• Protein
• Glucose
• Transient Xanthocromia
• Neutrophils

 

 

29. A 16-year-old male presented with a GCS of 12, following a fall downstairs. His CT scan is shown below. What is the diagnosis and the definitive operative management?

 

• Right extra-dural haematoma with burr hole evacuation
• Right subdural haematoma with burr hole evacuation
• Right extra-dural haematoma with craniotomy and evacuation of the haematoma
• Right subdural haematoma with craniotomy and evacuation of the haematoma
• Left extra-dural haematoma with craniotomy and evacuation of the haematoma

 

 

30. A 56 year old gentlemen presented into the Medical Assessment Unit with apraxia and confusion. He had a recent burr-hole evacuation of his chronic subdural haematoma. His CT scan reveals a re-collection. The neurosurgical registrar suggests an initial conservative approach. Which of the following would represent an accurate assessment of his advice?

 

• Regular Neuro-Observations
• Admit home
• Dexamethasone and Neuro-Observations on the ward
• IV Fluids and Neuro-Observations
• Ward Based Management including TEDs and Enoxaparin

 

 

31. Which of the following layers of the scalp is often used as the main tissue to ‘close’ following an incision?

• Skin
• S/c tissue
• Galeal aponeurosis
• Pericranium
• Connective tissue

 

 

32.What is the nervous supply to the dura mata?

• Facial nerve
• Trigeminal nerve
• Hypoglossal nerve
• Optic nerve
• Oculomotor nerve

 

 

33.A 23-year-old patient presents with an electrical shock like sensation running down her back of her neck. She has also noticed numbness and tingling in her hand that is made worse by heat. Which specific area of the brain is likely to be affected by her pathology?

• Frontal lobe
• Peri-ventricular
• Parietal lobe
• Intra-ventricular
• Temporal Lobe

 

 

34.A 56-year-old male presents with a 6-week history of being unable to get into his shoes and complaining his wedding rings don’t fit. He complains of blurred vision in both eyes with a severe headache. Which of the following investigations is most likely to reveal the patients diagnosis?

• Lumber Puncture
• MRI Pituitary
• CT Head
• Routine Blood Tests
• X-Ray Spine

 

35.A 26-year-old patient presents with right unilateral hearing loss and vertigo. Her Rinne’s and Weber’s test include the following results.

Weber’s: lateralising to the left ear

Rinne’s: AC>BC in both ears

Which immediate investigation should be performed?

• Audiogram
• Tympanogram
• CT Head
• Lumber Puncture
• Routine Blood Tests

 

 

36.A 56-year-old gentleman was diagnosed with a Total Anterior Circulation Stroke. After initial therapy he presented with the inability to finger count, perform mathematical calculations as well as the inability to write. Which of the following syndromes is present?

• Weber’s Syndrome
• Lateral Medullary Syndrome
• Locked in Syndrome
• Gerstmann’s Syndrome
• Kernohan’s Syndrome

 

 

37.A 65-year-old patient presented with reduced mobility. He was found to have altered handwriting and difficulty in initiating movement. Upon clinical examination he was found to have an upward gaze palsy. What anatomical region of the brain is affected in this pathology?

• Frontal Lobe
• Parietal Lobe
• Midbrain
• Pons
• Medulla

 

38.A 23-year-old gentleman had presented to AE with a seizure. His CT scan revealed a ring-enhancing lesion that subsequently proved to be a frontal GBM. Which of the following signs is associated with a ventral (inferior) frontal lesion.

• Wernicke’s Dysphasia
• Horizontal Gaze Palsy
• Broca’s Dysphasia
• Contralateral Weakness
• Unilateral Weakness

 

39.A 23-year-old female presented with conjugate visual gaze palsy. Upon examination towards left gaze: her left eye revealed nystagmus whilst her right eye failed to adduct toward the midline. What anatomical region of the brain is affected?

 

• Frontal Lobe
• Parietal Lobe
• Pontine Tegmentum
• Medial Longitudenal Fasciculus
• Cerebellum

 

40. A 21-year-old patient presents with severe pain on ocular movements. She presents as having reduced visual acuity and dyschromatopsia in the left eye. What visual defect is this patient likely to present with?

(a) Left homonymous hemianopia

(b) Left central Scotoma

(c) Left bitemporal hemianopia

(d) Total left eye blindness

(e) Left homonymous hemianopia with macular sparing

 

 

41. A 65-year-old patient presents with a non-painful ptosis of the left eye. He was unable to adduct the eye towards the midline. Both his pupils were equal and reactive to light. What initial investigation would you perform?

(a) CT Head

(b) MRI Head

(c) Vasculitic Screen

(d) Blood Glucose

(e) Lumber Puncture

 

42. An elderly gentlemen presents with a painful left eye and neck pain. His visual examination reveals pupil asymmetry (left eye 3+ and right eye 5), with a partial ptosis. Which of the following investigations should be performed as a matter of urgency?

(a) CT Head

(b) MRI Head

(c) Routine Blood tests

(d) Chest X-Ray

(e) MRA Head and Neck

 

43. A 46-year-old female presented to the Neurology ward with a headache, personality changes, blurred vision in the left eye, and an inability to comprehend information. Which of the following visual field defects is most likely to present?

(a) Bitemporal Hemianopia

(b) Homonymous hemianopia

(c) Superior Quadrantinopia

(d) Inferior Quadrantinopia

(e) Total Blindness in eye

 

44. A 56-year-old patient presents with numbness and tingling over the left hand. A diagnosis of carpal tunnel syndrome was made. Blood tests reveal a raised IGF-1 and Blood Glucose. The most likely visual defect associated with this syndrome includes:

(a) Superior Quadrantinopia

(b) Bitemporal Hemianopia

(c) Homonymous Hemianopia

(d) Inferior Quadrantinopia

(e) Total Blindness

 

45. A 65-year-old patient presents with fever, night sweats and weight loss. A CXR revealed calcification in the mid upper zone in the lung. Which of the following medication requires visual field testing prior to the initiation of treatment?

(a) Rifampicin

(b) Ethambutol

(c) Isoniazid

(d) Streptomycin

(e) Pyrazinamide

 

 

46. An 18-year-old male presented to AE with focal weakness in the left arm and left leg. A CT Head confirmed the presence of an ischaemic event. His visual examination revealed a pupillary aniscoria. Left eye (7) responsive to light, right eye (4) responsive to light. What is the likely diagnosis?

(a) Medication induced

(b) Argyll-Robertson

(c) Holmes-Adie

(d) Third Nerve Palsy

(d) Horner’s Syndrome

 

47. A 47-year-old female presents to the Neurology clinic after being referred by her GP for physiological aniscoria. Her right pupil size 7 and her left pupil size 4. Her left pupil was unreactive to light but slowly responded to accommodation. The remainder of her neurological examination was normal. What is the diagnosis?

(a) Holmes-Adie Syndrome

(b) Argyll-Robertson Pupil

(c) Holmes-Adie Pupil

(d) Horner’s Syndrome

(e) 3^rd nerve palsy

 

48. A 35-year-old female presents to the outpatient neurology clinic after being referred by the GP due to bilateral small pupils. Both pupils (size 2), did not respond to light but responded to accommodation. She had an additional sensory ataxia. What is the most likely diagnosis?

(a) Holmes-Adie Syndrome

(b) Argyll-Robertson Pupil

(c) Holmes-Adie Pupil

(d) Horner’s Syndrome

(e) 3^rd nerve palsy

 

49. A 16-year-old presents to the outpatient neurosurgery clinic with worsening headache and visual disturbance. A CT scan reveals ventriculomegaly at the level of the third ventricle. Examination reveals impaired upward gaze palsy and convergence-retraction nystagmus. The most likely diagnosis is?

(a) Holmes-Adie Syndrome

(b) Parinaud’s Syndrome

(c) Weber’s Syndrome

(d) Horner’s Syndrome

(e) Locked in Syndrome

 

 

50. A 60-year-old gentlemen presents to AE with sudden onset of blurred in the left eye vision. He has a PMH of atrial fibrillation, diabetes and hypertension. MRI head reveals a posterior cerebral artery infarct localised to the occipital lobe. Which of the following visual field defects is most likely?

(a) Contralateral Homonymous Hemianopia

(b) Superior Quadrantinopia

(c) Inferior Quadrantinopia

(d) Bitemporal Hemianopia

(e) Contralateral Homonymous Hemianopia with macular sparing

 

51. A 55-year-old patients with severe unilateral facial pain that is made worse by shaving and brushing the teeth. An MRI reveals neurovascular decompression. Neurological examination revealed impaired sensation of the left upper 1/3 of the face. What foramina of the skull does this cranial nerve leave the cranium to supply the skin?

(a) Superior Orbital Fissure

(b) Foramen Rotundum

(c) Foramen Ovale

(d) Internal Acoustic Meatus

(e) Optic Canal

 

52. A 45-year-old presents with right unilateral facial weakness (affecting the forehead and the mouth) and reduced blinking movement. He has also noted that background noise seems louder than normal with impaired sensation to the anterior aspect of the tongue. Given the above pathology, where is the likely lesion?

(a) Frontal Lobe

(b) Parotid Gland

(c) Stylomastoid Foramen

(d) At the level of the Geniculate Ganglion

(e) Cerebellum

 

 

53. You see a 26-year-old female who presented with headache and loss of hearing. The MRI scan is shown below. Which condition is associated with the pathology on the scan?

 

• Retinoblastoma
• Neurofibromatosis
• Parkinson’s Disease
• Guillen-Barre Syndrome
• Multiple Sclerosis

 

54. A 32-year-old female undergoes a retro-sigmoid craniotomy for a left acoustic neuroma. She unfortunately develops a lower motor neurone left facial nerve palsy. Which medication is an essential postoperative treatment given her above presentation?

(a) Dexamethasone

(b) Prednisolone

(c) Viscotears (eye lubricant)

(d) Morphine

(e) Paracetamol

 

 

55. A 65-year-old gentleman presents with dysphagia. Upper GIT excludes intra-abdominal pathology. Neurological examination reveals weakness and deviation of the tongue, and associated dysarthria. He has normal power in his neck. Which of these conditions is not associated with the above pathology?

(a) Myasthenia Gravis

(b) Motor Neurone Disease

(c) Posterior Circulation Stroke

(d) Jugular Foramen Syndrome

(e) Nasopharyngeal Carcinoma

 

56. A 73-year-old presents to AE with stridor and aspirational pneumonia. Flexible Nasal Endoscopy reveals bilateral vocal cord palsy. His wife had recently noticed exaggerated emotional responses. Clinic letters reveal that this patient is due for outpatient investigation with Speech and Language Therapy. The likely diagnosis is?

(a) Bulbar Palsy

(b) Pseudo-Bulbar Palsy

(c) Jugular Foramen Syndrome

(d) Syringo-bulbar

(e) Brainstem infarct

 

57. A 32-year-old gentlemen presents to the GP with headaches made worse by coughing. He also mentioned that he was unable to feel pain after he lacerated both his hands whilst working as a mechanic. His median nerve sensation was intact. Neurological examination reveals atrophy and fasciculation of the tongue. Which investigation is most likely to aid your diagnosis?

(a) MRI Cervical and Thoracic Spine

(b) EMG

(c) Routine Blood Tests

(d) CT Head

(e) MRI Head

 

58. A 21 year old gentlemen presents to the ward after suffering from a basal skull fracture. He develops acute confusion, sepsis with a normal CXR, Urine Dipstick and an exclusion of intra-abdominal pathology. His lumbar puncture is positive for meningitis. Which of these microorganisms is likely responsible for this:

 

• Neisseria Meningitis
• Haemophilus Influenza
• Staphylococcus Aureus
• Streptococcus Pneumonia
• Herpes Zoster Virus

 

59.A 46-year-old female presented with confusion, recurrent pyrexial episodes and seizures. She had an EEG that revealed ‘diffuse abnormalities’. What predominant area of the brain is affected with this pathology?

 

• Frontal Lobe
• Occipital Lobe
• Temporal Lobe
• Parietal Lobe
• Cerebellum

 

60. A 29-year-old patient who diagnosed with meningococcal septicaemia. He was initiated on Ceftriaxone. What class of antibiotic is prescribed?

 

• Quinolone
• Macrolide
• 1^st generation Cephalosporin
• 2^nd generation Cephalosporin
• 3^rd generation Cephalosporin

 

 

61.A 26-year-old gentleman IVDU presented with right arm weakness, confusion over the last 2 weeks. He was diagnosed with a Cerebral Abscess. He mentioned he had become progressively breathless prior to his weakness. He had a normal CXR. Examination revealed a mid-diastolic murmur loudest over the apex. Which of the following describes an accurate assessment of the examination findings, diagnosis and necessary investigation.

• Mitral Regurgitation, Infective Endocarditis, ECHO
• Mitral Stenosis, Lung Abscess, CT Chest
• Aortic Regurgitation, Infective Endocarditis, ECHO
• Mitral Stenosis, Infective Endocarditis, ECHO
• Tricuspid Regurgitation, Lung Abscess, ECHO

 

62.Which of these microbiological pathogens is associated with Meningitis in the elderly?

• Listeria Monocytogenes
• Haemophilus Influenza
• Staphylococcus Epidermidis
• Staphylococcus Aureus
• Streptococcus Pneumonia

 

63.A patient who had recently undergone a lumber puncture complained of a severe headache, improving when supine or coughing. What is the likely diagnosis?

• Raised Intra-Cranial Pressure
• Low Pressure Headache
• Infection
• Cranial Haematoma
• Anxiety

 

 

64. A 55-year-old patient with a history of ischaemic heart disease underwent a LP due to suspected encephalitis. 3 days letter he presents with severe back pain, radiation to the left leg. He had a residual volume of 700mls in his bladder. What is the likely diagnosis?

• Spinal Haematoma
• Iatrogenic Kidney Injury
• Post LP Back Pain
• Anxiety
• Post LP Infection

 

65.The following LP finding will be normal in Neisseria induced Meningitis.

• Blood Glucose
• Neutrophils
• Lymphocytes
• Protein
• Appearance

 

66.The spinal cord ends at the conus medullaris at which vertebral level?

• L1/L2
• L3/L5
• L5/S1
• T10/T11
• S3/S4

 

67.A patient who has a VP Shunt in situ for obstructive hydrocephalus had presented with acute confusion and reduced GCS. Inflammatory markers reveal a raised CRP and raised WCC. His CSF sample revealed Staphylococcus Epidermidis. Which particular virulence factor does this bacteria possess?

• K-antigen
• Toxin A and Toxin B
• Flagella
• Biofilm
• Spores

 

68. A 56-year-old diabetic patient presents into AE with a suspected brain tumour. She has a CT Head with contrast. After admission into the ward, her urine output deteriorates and blood tests reveal an acute kidney injury. Which medication could have contributed to this?

(a) Gliclazide

(b) Ceftriaxone

(c) Aciclovir

(d) Metformin

(e) Tolbutamide

 

67. A 28-year-old female presents with a severe occipital headache and neck stiffness. A CT Head excludes any acute intracranial haemorrhage, and a LP was negative for transient xanthocromia. She has a history of recurrent miscarriage. What would be the most appropriate form of management?

(a) Routine Blood Tests

(b) Psychiatric Intervention

(c) CT Venogram

(d) Repeat CT scan 6 weeks

(e) CT Angiography

 

 

68. A 66 year old gentlemen presents with a severe unilateral headache and weight loss. He reports difficulty in getting up and downstairs. Blood tests reveal raised CRP and WCC. What is the most definitive diagnostic investigation?

(a) CT Head

(b) Temporal Artery Biopsy

(c) Vasculitic Screen

(d) EMG of upper and lower Limbs

(e) MRA

 

69. A 24-year-old female presents into AE with a unilateral headache. She describes it as a pain behind her eye with associated lacrimation and salivation. She has a history of restrictive cardiomyopathy. Which of these medications would be contra-indicated?

(a) Sumatriptan injection

(b) Oral Sumatriptan

(c) Verapamil

(d) Paracetamol

(e) Codeine Phosphate

 

70. A young female patient presents with a history of migraines. She has no previous medical conditions. Her GP has initiated her on Sumatriptan. What is the mechanism of action of this medication?

(a) 5HT1a agonist

(b) 5T1a antagonist

(c) 5HT1b agonist

(d) 5HT1b antagonist

(e) 5HT2 agonist

 

71. A 56-year-old gentlemen presents with a 10/10 unilateral headache, severe ocular pain with associated nausea and vomiting. Visual examination reveals left conjunctival injection with a fixed non-reactive pupil. Visual acuity is reduced to finger counting. What would be the most appropriate next step in the management of this patient?

(a) Immediate CT Head

(b) Immediate MRI Head

(c) Urgent Referral to Ophthalmology

(d) Discharge Home with analgesia

(e) Urgent Referral to Neurology

 

72. A 33-year-old female presents with a bilateral frontal headache, made worse by anxiety and stress. She has a PMH of irritable bowel syndrome and fibromyalgia. She has some associated neck stiffness but no other significant examination findings. What is the likely diagnosis?

(a) Tension Headache

(b) Migraine with an aura

(c) Meningitis

(d) Encephalitis

(e) Cluster Headache

 

73. A 43-year-old lady presented to AE with collapse and a severe headache. She presented with the following CT scan. The appearances are consistent with?

 

• Glioblastoma Multiforme
• Meningioma
• Lymphoma
• Cerebral Abscess
• Metastatic Lytic Lesions

 

74. A 45-year-old female presents to AE with an initial seizure. A CT scan reveals suspected metastatic lesions. Which of these is the most likely primary in a female?

(a) Lung

(b) Kidney

(c) Skin

(d) Breast

(e) Colo-Rectal

 

78. A 65-year-old male presents to AE with headache, ataxia and vomiting. He had been under investigation for a suspected lesion on his liver. A CT scan reveals metastatic deposits. What is the most common primary site for metastasis to the brain in a male?

(a) Lung

(b) Kidney

(c) Testicular

(d) Skin

(e) Colorectal

 

79. The use of Dexamethasone in the management of a patient with a cerebral tumour should initially be avoided in which suspected diagnosis?

(a) Meningioma

(b) Glioblastoma Multiforme

(c) Lymphoma

(d) Choroid Plexus Tumour

(e) Metastasis

 

80. CNS Lymphoma’s are associated with associated with which condition?

(a) HIV

(b) Multiple Sclerosis

(c) Guillen-Barre Syndrome

(d) Phaecromocytoma

(e) Neurofibromatosis

 

81. A 24-year-old gentlemen presented into the AE department with a severe headache and left sided focal weakness. He recently had a left neck abscess drained. A CT with contrast revealed multiple ‘ring’ enhancing lesions. His WCC count was 7.1 and a CRP 22. An MRI Diffusion Weighted scan revealed hypo-intensity on T1 weighted imaging. The likely diagnosis is?

(a) Cerebral Abscess

(b) Glioblastoma Multiforme

(c) Meningioma

(d) CNS Lymphoma

(e) Choroid Plexus Carcinoma

 

82. A 15 year old gentlemen presents with headache and visual disturbance. Examination revealed upward gaze palsy. Blood tests reveal raised B-HcG. The MRI scan is shown below:

 

• 3^rd ventricular colloid cyst
• Glioblastoma Multiforme
• Pineal Gland Tumour
• Meningioma
• Metastasis

 

 

A 32-year-old female presents with secondary amenorrhea and galactorrhea. Her blood tests revealed:

Prolactin 90mg/ml (20mg/ml)

Sodium= 120mmol/l

Potassium= 5.5mmol/l

TSH= low

T3/T4= low

IGF-1= normal

An MRI revealed a large pituitary adenoma. What is the significance of a raised prolactin?

• Hypopituitarism
• Pituitary Stalk Effect
• Laboratory error
• Solitary Prolactinoma
• Pituitary Apoplexy

 

84. A 26 year old gentlemen presents to AE with vomiting, diarrhoea. His observations included a BP 80/50 Pulse 120. His BM 3.0mmol/l. Blood tests reveal a Na+ 97mmol/l and K+ 6.5mmol/l. CT scan: supra sellar mass consistent with pituitary adenoma. Which key investigation would you perform next?

(a) ACTH

(b) 24 hour urinary cortisol

(c) Random Cortisol

(d) 9am cortisol

(e) Midnight Cortisol

 

 

85. A patient who was referred to the Neuro-endocrine clinic had a pituitary blood profile taken. Which of the following tests is least likely to be reliable?

(a) IGF-1

(b) Cortisol

(c) Thyroid Function Tests

(d) Prolactin

(e) Growth Hormone

 

86. A 10-year-old child is referred to the GP because of short stature. His routine blood tests including gastroenterological investigations were normal. A T1 weighted MRI sequence was performed that showed a vividly enhancing supra-tentorial mass compressing the optic chiasm. It had been described by the radiologist as having an ‘oil-machinery’ appearance. What is the most likely diagnosis?

(a) Pituitary adenoma

(b) Metastasis

(c) Craniopharyngioma

(d) Internal Carotid Artery Aneurysm

(e) Meningioma

 

87. A patient who was recently diagnosed with cerebral metastasis was initiated on Dexamethasone. Which of the following is an unrecognised complication of this treatment?

(a) Osteonecrosis of femoral head

(b) Hypertension

(c) Osteoporosis

(d) Diabetes Mellitus

(e) Osteoarthritis

 

88. Which of the following scoring systems is often used to assess patient’s performance status in those who have been diagnosed with a Glioblastoma Multiforme?

(a) Karnoffsky’s Score

(b) Rankin’s Score

(c) MRC Grading Score

(d) WHO Performance status scores

(e) ABCD2 score

 

89. A 56-year-old male undergoes a frontal craniotomy for right sphenoid wing meningioma. Post operatively his GCS progressively deteriorates. His current GCS E2, M3, V1. Blood tests reveal mildly raised CRP and WCC. His Observations BP: 180/110 Pulse: 45 Apyrexial

 

What is the most likely cause for his progressive deterioration in his GCS?

(a) Drug induced

(b) Seizures

(c) Hydrocephalus

(d) Post-Operative Haematoma

(e) Post-Operative Infection

 

90. With regards to the management of GBM; which oncological management option is given only once during therapy?

(a) Macroscopic Surgical Resection

(b) Chemotherapy

(c) Radiotherapy

(d) Intra-Cerebral Chemotherapy Wafers

(e) Management of Obstructive Hydrocephalus

 

91. A 35-year-old patient presented with blistering on both his hands. Neurological examination revealed impaired pain and temperature sensation bilaterally. An MRI scan revealed an obstructive hydrocephalus and the presence of a syrinx. What is the most likely diagnosis?

• Arnold-Chiari Malformation
• Sub-Arachnoid Haemorrhage
• Congenital Aqueduct Stenosis
• Pineal gland tumour
• Craniopharyngioma

 

 

92. A 19-year-old patient undergoes trans-sphenoidal surgery for a macro pituitary adenoma. She develops CSF leak and pyrexia, and requires a lumbar puncture to exclude meningitis. A CT scan reveals the presence of an obstructive hydrocephalus.

What part of the ventricular system is affected in this pathology?

• 3^rd ventricle
• 4^th ventricle
• Foramen on Munro
• Foramen of Luschka
• Foramen of Magendie

 

 

93. A 75 year old is admitted to the frailty unit with recurrent falls. A collateral history revealed a progressive decline in memory over the last year. She was found to be incontinent during her stay. What is the most likely diagnosis?

 

 

• Normal Pressure Hydrocephalus
• Hydrocephalus Ex-Vacuo
• Communicating Hydrocephalus
• Obstructive Hydrocephalus
• Benign Intra-Cranial Hypertension

 

94. A 55 year old patient with a history of Down’s syndrome had been noted to have reduced memory and changes to her personality. A CT scan and MRI scan were performed to exclude any intra-cranial pathology. What is the likely cause of her ventriculomegaly?

 

 

• Normal Pressure Hydrocephalus
• Hydrocephalus Ex Vacuo
• Communicating Hydrocephalus
• Obstructive Hydrocephalus
• Benign Intra-Cranial Hypertension

 

 

95. A 33-year-old patient with a background of Polycystic Ovarian Syndrome presents to the Neurology Outpatient Department with headache and blurred vision. Fundoscopy reveals bilateral papilledema. A LP reveals raised CSF Pressure of 20mmHg. An MRI excludes any hydrocephalus or any intra-cranial mass lesion. Which of the following investigation is essential prior to making the diagnosis described above?

(a) MRA (Angiography)

(b) MRV (Venography)

(c) Routine Blood Tests

(d) Shunt Series X-Rays

(e) Repeat CT Head 6 months

 

96. A 14-year-old patient presents to AE with a history of cerebral aqueduct stenosis. He presented with drowsiness, vomiting and was admitted because of a seizure. He had a VP Shunt Revision 1 year ago. CT Head reveals ventriculomegaly.

Examination revealed swelling anterior to the clavicle. Which of the following investigations would be important in the management of this patient?

• US Clavicle
• Routine Blood tests
• MRI scan
• Shunt Series X-Rays
• MRA

 

97. A 22 year old pregnant patient had a long history of sciatica. She presented with new onset urinary incontinence, and altered peri-anal sensation. She had weakness of plantar-flexion with altered sensation over the dorsum of the foot. Thoe most likely diagnosis is?

• Conus Medullaris Syndrome
• Cauda Equina Syndrome
• Metastatic Spinal Cord Compression
• Cervical cord lesion
• Thoracic spinal cord lesion

 

98. The MRI scan shown below indicates:

(a) T2 weighted image indicating a large disc prolapse causing significant CSF effacement and likely thecal compression and cauda equina syndrome

(b) T1 weighted imaging indicating a large disc prolapse causing significant CSF effacement and likely thecal compression and cauda equina syndrome

(c) T2 weighted indicating a large disc prolapse affecting the spinal cord

(d) T1 weighted image indicating a large disc prolapse affecting the spinal cord

(e) No pathology

 

99. The axial MRI scan shown below indicates the following:

 

(a) T2 weighted image indicating a large disc prolapse causing significant CSF effacement  and cauda equina syndrome

(b) T1 weighted imaging indicating a large disc prolapse causing significant CSF effacement and cauda equina syndrome

(c) T2 weighted indicating a large disc prolapse affecting the spinal cord

(d) T1 weighted image indicating a large disc prolapse affecting the spinal cord

(e) No pathology

 

100. Which is the most common tumour to metastasis to bone?

(a) Breast

(b) Prostate

(c) Liver

(d) Renal

(e) Colorectal