Neurology Medicine 10 Single Best Answer (SBA)
If questions aren't showing, refresh the page.
1. A 68-year-old man presents with sudden onset right-sided weakness and slurred speech. On examination, there is a right facial droop and hemiparesis. CT head shows no evidence of haemorrhage. What is the most appropriate next step in management?
Answer: Initiate IV thrombolysis
For an acute ischaemic stroke, after excluding haemorrhage on CT, IV thrombolysis is indicated if the patient is within the treatment window (usually 4.5 hours) and has no contraindications.
2. What is the primary pathophysiological mechanism underlying aneurysmal subarachnoid haemorrhage?
Answer: Spontaneous rupture of a saccular aneurysm
The classic cause of subarachnoid haemorrhage is the rupture of a saccular (berry) aneurysm, often at arterial branch points in the Circle of Willis.
3. A 72-year-old woman reports a 20-minute episode of left-sided weakness and slurred speech that resolved spontaneously. She has a history of hypertension and atrial fibrillation. What is the most appropriate initial investigation?
Answer: MRI brain with diffusion-weighted imaging
For a suspected TIA, MRI with DWI has a high sensitivity for detecting acute ischaemia. Other investigations follow, but identifying the lesion is the first step.
4. A 30-year-old woman presents with a 6-month history of bilateral, pressing headaches. She is worried it might be a brain tumour. Examination is unremarkable. What is the most appropriate response?
Answer: Reassure and discuss triggers such as stress and posture
Tension headaches are often related to stress and poor posture. Patient reassurance is crucial once serious causes are ruled out clinically.
5. A 19-year-old university student presents with fever, neck stiffness, and photophobia. Lumbar puncture reveals turbid CSF with high protein, low glucose, and neutrophil predominance. What is the most likely causative organism?
Answer: Neisseria meningitidis
In a young adult with acute meningitis, N. meningitidis is a leading cause. The CSF profile with low glucose, high protein, and neutrophil predominance is typical of bacterial meningitis.
6. A 45-year-old man presents with fever, confusion, and new-onset seizures. MRI shows temporal lobe hyperintensity. What is the most appropriate immediate treatment?
Answer: Start IV acyclovir
HSV encephalitis classically affects the temporal lobes. Immediate IV acyclovir is critical to reduce morbidity and mortality.
7. A 50-year-old man presents with fever, headache, and focal neurological deficits. CT shows a ring-enhancing lesion with surrounding oedema. What is the most common complication if untreated?
Answer: Rupture into the ventricles
Brain abscesses can expand and rupture into the ventricular system, causing a severe and often fatal outcome if not treated urgently.
8. A 70-year-old woman with a vesicular rash in a dermatomal distribution is prescribed valaciclovir. What is the primary mechanism of action of this drug?
Answer: Inhibition of viral DNA polymerase
Valaciclovir is converted to acyclovir, which inhibits the viral DNA polymerase of herpes viruses, preventing viral replication.
9. What is the most effective intervention to prevent the progression of diabetic nephropathy?
Answer: Tight glycaemic control
Maintaining good control of blood glucose significantly reduces the risk and progression of diabetic nephropathy.
10. A 55-year-old man with diabetic neuropathy reports worsening pain despite treatment. He requests an alternative medication, but his GP believes this is unlikely to help. How should the GP proceed?
Answer: Explain the reasons for declining the request and discuss alternative options
Ethical, patient-centred care involves clear communication. If a requested treatment is inappropriate, the GP should explain why, explore patient concerns, and offer alternatives.
Total Score: 0/10