Test Your Neurology Knowledge Quiz

2.

A 32 year old gentleman is brought into A&E by ambulance following a car accident. He has multiple injuries, and is unresponsive. After his airway, breathing and circulation are assessed and stabilised, the doctor goes to assess his level of consciousness using the Glasgow Coma Scale (GCS). He does not open his eyes at any stage, but tries to withdraw his arm and groans in response to painful stimuli. What is his GCS?

Explanation
The Glasgow Coma Scale (GCS) was initially designed to assess level of consciousness following head injury, but is now more widely used and applied to all acute medical and trauma patients. It consists of 3 components; Eye response (1-4 points), Verbal response (1-5 points) and Motor response (1-6 points), giving a total out of 15, where 3 is the minimum score and 15 the maximum score.

The scale is as follows:

Eye - 1 = Does not open
2 = opens in response to painful stimuli
3 = opens in response to voice
4 = opens eyes spontaneously

Verbal 1 = Makes no sounds I
2 = incomprehensible sounds
3 = Utters inappropriate words
4 = Confused, disoriented
5 = Oriented, converses normally

Motor response 1 = Makes no movements
2 = Extension to painful stimuli (decerebrate response)
3 = Abnormal flexion to painful stimuli (decorticate response)
4 = Flexion / Withdrawal to painful stimuli
5 = Localizes painful stimuli
6 = Obeys commands

From this it is apparent that an alert patient would have a GCS of 15.
In the above scenario, the patient's score can be calculated thus:
E = 1, V = 2, M = 4 = total 7/15

As a general rule, patients with a GCS < 8 are unable to protect their own airway and would need intubation and monitoring on intensive care if this was deemed appropriate.

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3.

A 27 year old woman presents to her GP with a history of severe headache. She reports that these headaches have occurred 4 times in the last 3 months and have been predominantly left -sided and associated with visual disturbance and vomiting. They last several hours at a time and are so severe she has been unable to go to work. She reports that she is able to predict when she will get one of these headaches as the day before she is off her food, nauseated and the visual disturbances, which are flashing lights across her field of vision, begin. What is the likely diagnosis?

Epilepsy
Temporal arteritis
Space occupying lesion
Migraine
Cluster headache

Correct Answer

A. Migraine

Explanation

The likely diagnosis for this patient is migraine. Migraine headaches are often characterized by severe pain, typically on one side of the head, along with other symptoms such as visual disturbances (flashing lights), nausea, and vomiting. The fact that the patient is able to predict when she will get a headache based on premonitory symptoms (loss of appetite, nausea, visual disturbances) is also consistent with migraine. Epilepsy, temporal arteritis, space occupying lesion, and cluster headache are less likely based on the given information.

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4.

A 68 year old woman presents with double vision. On examination she has a ptosis of her left eye and when her eyelid is raised the eye is pointing inferiorly and laterally. On assessing her eye movements, these were normal in the right eye, but her left eye was unable to look right or upwards. Her left pupil was dilated. What is the likely diagnosis?

Horner's syndrome
Left 3rd nerve palsy
Left 4th nerve palsy
Left 6th nerve palsy

Correct Answer

A. Left 3rd nerve palsy

Explanation

http://en.wikipedia.org/wiki/Oculomotor_nerve_palsy

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5.

Which of the following are risk factors for stroke?

Hypotension
Atrial fibrillation
Diabetes mellitus
Hypocholesterolaemia
Family history of stroke

Correct Answer(s)

A. Atrial fibrillation
A. Diabetes mellitus
A. Family history of stroke

Explanation

Atrial fibrillation: This heart condition increases the risk of stroke because it can cause blood clots to form in the heart, which can then travel to the brain.
Diabetes mellitus: High blood sugar levels can damage blood vessels and increase the risk of stroke.
Family history of stroke: Genetics can play a role in an individual's susceptibility to stroke.
Hypotension (low blood pressure) and hypocholesterolaemia (low cholesterol levels) are not typically considered major risk factors for stroke. In fact, high blood pressure (hypertension) and high cholesterol levels (hypercholesterolemia) are more commonly associated with an increased risk of stroke.

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6.

A 44 year old gentleman presents to A&E with a severe headache. He said it came on quickly, within 30 seconds, and is at the back of his head. He reports feeling nauseated and 'unsteady'. On examination he has mild neck stiffness, nystagmus on left and right gaze and is walking with a very unsteady, broad-based gate, wobbling from side-to-side. What is the likely diagnosis?

Subarachnoid Haemorrhage
Migraine
Cerebellar infarction
Cluster headache
Meningitis

Correct Answer

A. Subarachnoid Haemorrhage

Explanation

The sudden onset occipital headache is 'classical' of a subarachnoid haemorrhage (although it doesn't always present this way). The neck stiffness may be due to meningeal irritation from bleeding, and the cerebellar signs (see below) are due to the extrinsic pressure from blood around the cerebellum. An infarction is typically painless.

Cerebellar signs = DANISH

Dysdiadochokinesis
Ataxia
Nystagmus
Intention tremor
Slurred speech
Hypotonia

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7.

A 13 year old boy presents with facial weakness. On examination he has paralysis of his facial muscles on the left hand side, including the left side of his forehead. He has a mild ptosis of his left eye. What is the likely diagnosis?

Todd's paresis
Bell's palsy
Ischaemic stroke
Intracerebral haemorrhage
Space-occupying lesion

Correct Answer

A. Bell's palsy

Explanation

When assessing facial weakness, it is important to establish if there is sparing of the muscles of the forehead. Control of the forehead muscles has bilateral upper motor neurone input, so an upper motor neurone lesion (unless it was bilateral) would spare, or partially spare, the forehead muscles as there is input from the contralateral side. A lower motor neurone lesion would not spare the forehead.
Bell's palsy is a unilateral lower motor neurone facial weakness.

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Test Your Neurology Knowledge Quiz

Which of the following are clinical signs of an upper motor neurone problem?

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Which of the following are risk factors for stroke?

A 13 year old boy presents with facial weakness. On examination he has paralysis of his facial muscles on the left hand side, including the left side of his forehead. He has a mild ptosis of his left eye. What is the likely diagnosis?