Head trauma (650/1700)

An employer sent his worker to the ED after having hit his head on a machine. Exam: normal.
What is the single most likely inv you would do?
a. Skull XR
b. CT head
c. MRI head
d. Reassure

Speech Impairment (1670/1700)

A young man develops nonfluent, effortful speech with dysarthria. He is able to undertsand speech. He fails to repeat the sentence. What would you do next?#

a. XR skull
b. Non-contrast CT brain
c. Contrast CT brain
d. Contrast MRI optic nerves
e. 4-vessel cerebral angiogram
f. Single vessel cerebral angiogram
g. Cerebral angiography
h. MRI frontal lobe
i. MRI pituitary gland
j. MRI temporal lobe

Upright gaze diplopia (938/1700)

A 33yo female complains of diplopia on upright gaze. Exam: ptosis can be seen. There are no
other complains or any significant PMH. What is the most appropriate inv for him?
a. Ophthalmoscopy
b. Visual field test
c. TFT
d. CT
e. Checking red reflex

Speaking difficulty and left sided paralysis (553/1700)

A 69yo woman has had a stroke. Her left upper and lower limbs are paralyzed and she is having
difficulty in speaking. Which anatomical site is most likely affected?
a. Hippocampus
b. Cerebellum
c. Internal capsule
d. Thalamus
e. Brain stem

Headache, confusion, impaired vision (546/1700)

A 75yo nursing home resident complains of headache, confusion and impaired vision for 4days.
She has multiple bruises on her head. What is the most likely cause of confusion in this pt/
a. Alcohol intoxication
b. Infection
c. Subdural hematoma
d. Hypoglycemia
e. Hyponatremia

Falls, broad based gait, incontinence (545/1700)

545. A 73yo male presents with a 12m hx of falls. His relatives have also noticed rather strange
behavior of late and more recently he has had episodes of enuresis. Exam: disorientation to
time and place, broad-based, clumsy gait. What is the most probable dx?

a. Dementia
b. Pituitary adenoma
c. CVD
d. Syringomyelia
e. Normal pressure hydrocephalus

Burn marks, weakness (541/1700)

A 50yo lady with weak limbs when examined was found to have burn marks on finger tips,
wasted and weak hands with diminished reflexes. She also has weak spastic legs and dissociated
sensory loss. What is the dx?

a. MS
b. Syringomyelia
c. MND
d. Guillian-barre
e. Freidriech’s ataxia

Seizures (538/1700)

A 63yo man presents after having a seizure. Exam: alert, orientated, inattention on the left side
and hyperreflexia of the arm. What is the most probable dx?
a. Cerebral tumor
b. Pituitary adenoma
c. Cerebellar abscess
d. Huntingtons chorea
e. Parkinsonism

Blurred vision and intermittent clumsiness (537/1700)

A woman presented with blurred vision and intermittent clumsiness for 3m. Reflexes are brisk inher arm and optic disc is pale. What is the single most appropriate test to confirm dx?

a. CSF analysis
b. CT
c. MRI
d. EEG
e. EMG

Sudden onset severe back pain (878/1700)

A 20yo fit man suddenly developed severe lower back pain as getting up from bed. What is the single most probable dx?
a. Paget’s disease
b. Multiple myeloma
c. PID
d. AS
e. Spondylosis

Back pain (508/1700)

A 50yo man presents to the ED with acute back pain radiating down to his legs. Pain which is
usually relieved by lying down and exacerbated by long walks and prolong sitting. What inv
would be the best option?
a. MRI
b. CT spine
c. XR spine
d. Dual energy XR abruptiometry
e. Serum paraprotein electrophoresis

Parkinson's disease (502/1700)

For a pt presenting with Parkinson’s disease which of the following drugs is most useful in the
management of the tremor?
a. Apomorphine
b. Cabergoline
c. Selegiline
d. Amantadine
e. Benzhexol

Cafe au lait spots - Inheritance? (634/1700)

A 32yo female with axillary freckles and café au lait spots wants to know the chances of her child also having similar condition.
a. 1:2
b. 1:4
c. No genetic link
d. 1:16
e. Depends on the genetic make up of the partner

Headache and loss of vision (487/1700)

A 62yo lady presents with right sided headache and loss of vision. What is the single most inv?
a. ESR
b. BUE
c. CT head
d. XR orbit
e. IOP

Type of seizure (485/1700)

A 6m baby had LOC after which he had jerky movement of hands and feet. What is the most
probable dx?
a. Infantile spasm
b. Absence
c. Partial simple seizure
d. Atonic seizure
e. Partial complex

Brain localization (475/1700)

A 32yo woman presents to the ED with headache and vomiting. She was decorating her ceiling
that morning when the headache began, felt mainly occipital with neck pain. Some 2hs later she
felt nauseated, vomited and was unable to walk. She also noticed that her voice had altered. She
takes no reg meds and has no significant PMH. Exam: acuity, field and fundi are normal. She has
upbeat nystagmus in all directions of gaze with normal facial muscles and tongue movements.
Her uvulas deviated to the right and her speech is slurred. Limb exam: left arm past-pointing and
dysdiadochokinesis with reduced pin prick sensation in her right arm and leg. Although power is
normal, she can’t walk as she feels too unsteady. Where is the most likely site of lesion?
a. Right medial medulla
b. Left medial pons
c. Left cerebellar hemisphere
d. Right lateral medulla
e. Left lateral medulla

Bruises around the orbital area, GCS drops to 7 (463/1700)

A young adult presents to the ED after a motorcycle crash. The pt has bruises around the left
orbital area. GCS=13, examination notes alcoholic breath. Shortly afterwards, his GCS drops to 7.
What is the single most important initial assessment test?

a. MRI brain
b. CT brain
c. CXR
d. CT angio brain
e. Head XR

Cause of Sleep apnea (459/1700)

459. A 56yo man has symptoms of sleep apnea and daytime headaches and somnolence. Spirometry
shows a decreased tidal volume and vital capacity. What is the single most appropriate dx?
a. Ankylosing spondylitis
b. Churg-strauss syndrome
c. Good pasture syndrome
d. Motor neuron disease
e. Progressive massive fibrosis
f. Spinal cord compression

Pain, Weakness, Stiff legs, Swallowing difficulties (452/1700)

A 50yo woman presents following a fall. She reports pain and weakness in her hands for several
months, stiff legs, swallowing difficulties, and has bilateral wasting of the small muscles of her
hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs
show increased tone, pyramidal weakness and hyper-reflexia with extensor plantars. Pain and
temp sensation are impaired in the upper limbs. What is the most likely dx?
a. MS
b. MND
c. Syringobulbia
d. Syringomyelia
e. Myasthenia gravis

Sudden loss of vision (443/1700)

A 38yo female presents with sudden loss of vision but fundoscopy is normal. She a similar
episode about 1 year ago which resolved completely within 3m. Exam: mild weakness of right
upper limb and exaggerated reflexes. What is the single most appropriate tx?

a. Pan retinal photo coagulation
b. Pilocarpine eye drops
c. Corticosteroids
d. Peripheral iridectomy
e. Surgical extraction of lens