A normally fit and well 76 year old lady with a three day history of urinary frequency and dysuria is admitted via Accident and Emergency. On admission, you are told by the health care assistant that her AMTS (Abbreviated Mental Test Score) is 3/10. What condition could you reliably deduce from this test score?

A Delirium

B Dementia

C Depression

D Encephalopathy

E Increased suicide risk

A 67 year old man is seen in the neurology clinic after being referred by his GP after experiencing some difficulties with walking. On examination, his foot appears to hang in the air when lifted, with his toes directed towards the floor. He states he has to raise his leg higher in the air than normal, so as to avoid scraping his toes on the ground when he walks. Which nerve is most likely to have been damaged to cause this disorder?

A Common peroneal nerve

B Medial planter

C Perforating cutaneous nerve

D Superficial fibular nerve

E Saphenous nerve

A 74 year old lady, with no existing medical comorbidities, presents to clinic with worsening memory problems. She has noticed this for around 6 months, however her daughter states that she first felt this became a problem over 5 years ago. Previously she had encountered problems with word finding and was forgetting important appointments, however she is now more frequently confused, is reluctant to eat and is increasingly apathetic. Her MMSE score is presently 18/30. What would be the most appropriate pharmacological management for this condition?

A Amitryptyline

B Lorazepam

C Memantine

D Rivastigmine

E Sertraline

A 45 year old man presents to neurology clinic for review. He had epilepsy as a child and teenager, however this was well controlled for years on phenytoin. He was admitted to hospital 3 months ago with dizziness, and was found to have a megaloblastic anaemia, which his haematologist felt was due to the phenytoin. Therefore this medication was stopped at this time. He has been seizure-free during this period. He is asking about driving in the UK. What advice should he be given regarding his driving?

A He must inform the DVLA and must not drive for a period of 3 months

B He must inform the DVLA and must not drive for a period of 6 months

C He must inform the DVLA and must not drive for a period of 12 months

D He must inform the DVLA and must not drive for a period of 18 months

E There is no need to inform the DVLA

A 22 year old man is admitted to hospital via Accident and Emergency having experienced a fit. His partner states it lasted for around 2 minutes, during which time he fell to the ground and made involuntary ‘jerking’ movements of his arms and legs. He was un?conscious during this time. He denies drug use and does not drink alcohol. He does not take regular medication, however states that this kind of episode has been happening to him once every 6 months, for the past 3 years. The last episode was similar, though accompanied by incontinence of urine. You suspect the patient has epilepsy. How may a diagnosis of epilepsy be made?

A Ambulatory EEG

B Clinical diagnosis

C CT head

D MRI head

E Standard EEG

A 44 year old man, who works in a factory and is a smoker, presents to his GP. He states he has been having an intense headache for about 6 weeks, which has been worse at night, particularly when he is sat up in bed. The pain is unilateral, behind his left eye, and he states that it is so bad that he has been tempted to ‘bash his head off the wall’ to make it go away. The pain episodes last for about 3 hours at a time, with little rest periods. There is no aura. What is the most appropriate initial pharmacological treatment to manage these acute attacks?

A Amitriptyline oral

B Home oxygen

C Sumatriptan nasal spray

D Sumatriptan SC

E Verapamil oral

A 75 year old woman presents to her GP with ‘a terrible headache’. It has been going on for about two or three days now. She has been feeling generally unwell alongside this, with fever. She noticed increased pain when brushing her hair this morning. What would be the most appropriate initial investigation?

A C-reactive protein

B CT head

C Erythrocyte sedimentation rate

D Lumbar puncture

E Opthalmoscopy

A 65 year old lady with a history of multiple sclerosis is admitted to hospital with urinary incontinence and urinary frequency. She is normally dependent on her husband and carers she has three times per day. She is not catheterised and previously has not experienced urinary dysfunction. What is the most appropriate next step in investigation and management?

A Commence desmopressin

B Recommend pelvic floor exercises

C Start oxybutynin

D Urinary catheterisation

E Urinalysis for urinary tract infection

A 66 year old lady has presented to clinic to discuss her long term neurological problem. She has had reduced vision in her left eye, which was of sudden onset. She has weakness in both her arms and her legs, and on examination has hyperreflexia. She also has experienced urinary incontinence and numbness in both arms. The symptoms are worst on a warm day. She states that her symptoms initially came and went in ‘relapses’, which got worse over time. However, since around 6 months ago, her symptoms have just been gradually getting worse and she can no longer walk, requiring carers three times per day. What is the most likely cause for this presentation?

A Creutzfeldt-Jacob Disease

B Motor Neurone Disease

C Relapsing Remitting Multiple Sclerosis

D Primary Progressive Multiple Sclerosis

E Secondary Progressive Multiple Sclerosis

A 26 year old man presents to his GP with worsening fatigue and weakness, particularly on his face. He states that this is worse after exercise. By the end of the day he is having difficulty seeing as he complains that his eyelids are drooping. The weakness is also noted on examination in his proximal muscles. Ice test is positive. Which antibody is likely to be positive in this condition?

A Acetylcholine receptor antibody

B cANCA

C dsDNA

D Anti-Ro

E Anti-Jo

A 71 year old man presents to his GP with his wife. He has a history of Parkinson’s disease, and his GP started him on new medical therapy last month. His wife is particularly distressed because she states that her husband has ‘spent most of our pension on online casino gambling’. On further questioning, you find that he has also borrowed money to buy seventeen slow cookers for his friends. Which pharmacological therapy may have contributed to this therapy?

A Amantadine

B L-Dopa

C Procyclidine

D Ropinirole

E Selegeline

An 83 year old gentleman presents to clinic with his daughter, who is concerned about her dad’s memory. She states that it has been in decline for some time now, but, more worryingly, has been accompanied by periods where he states he can see his wife bringing him biscuits. His wife unfortunately passed away three years ago. He has poor concentration, and she states that he is much slower at getting about the house than before. On examination, he has a unilateral pill-rolling tremor. What is the most likely cause of this presentation?

A Alzheimer’s disease

B Dementia with lewy bodies

C Depression

D Space occupying lesion

E Vascular dementia

A 37 year old lady with a history of cirrhosis secondary to alcohol is an inpatient on the gastrointestinal ward. She has fluctuating confusion and lethargy, and believes that she is running 100m at the Olympic games. She has not had a fall, and CT head on admission was normal. On examination, she has asterixis, scleral icterus and exaggerated reflexes. What blood test would be most appropriate to undertake at this stage to identify the cause of her confusion?

A Ammonia

B Ceruloplasmin

C CRP

D Prothrombin time

E Sodium

A 45 year old woman has presented with weakness, which has been going on for about two days. She is otherwise very well: indeed the only time she has been unwell recently was when she had some poorly-cooked meat a few weeks ago. The weakness began in both her feet and has got progressively worse, now leaving her too weak to walk and struggling to take deep breaths. On examination she has hyporeflexia. What is the most likely cause of this pathology?

A Guillan-Barré syndrome

B Miller-Fisher syndrome

C Motor Neurone Disease

D Polymyositis

E Spinal cord compression

A 31 year old man is involved in a road traffic accident and is brought straight to Accident and Emergency. On presentation, his eyes are opening to pain. He is making incoherent sounds and he localises to pain. What is this gentleman’s GCS?

A 7

B 8

C 9

D 10

E 11

Mr Jones is a 51 year old gentleman who was previously fit and well. He has presented to his GP with dysphagia for one month. He has been choking on liquids but managing more solid foods. His wife has been struggling to understand him as she feels his speech has gradually become quieter and a bit slurred. He has also been tripping over more often, particularly when raising his left leg when climbing steps. On cranial nerves examination he has a weak, fasiculating tongue and jaw jerk is normal. What is the most likely diagnosis?

A Central pontine myelinolysis

B Motor neurone disease

C Multiple sclerosis

D Myasthenia gravis

E Pseudobulbar palsy

Mr Smith is a 65 year old gentleman who has presented to his GP with falls. He does not lose consciousness and usually falls due to tripping over. He has been becoming clumsier over the last 3 months and has been stumbling more often. He has not noticed any changes to his speech or vision. On examination, he has bilateral arm and leg weakness with a combination of both upper and motor neurological signs. Mr Smith is referred to a neurologist who confirms your suspected diagnosis. Which treatment is most likely to improve his prognosis?

A Amytriptyline

B Baclofen

C Hyoscine hydrobromide

D Non-invasive ventilation

E Riluzole

Mrs Hopper is a 38 year old lady who has presented to A&E with a headache. It came on suddenly at the back of her head whilst she was lifting her three year old son up into the car. She describes it as ‘thumping’ all over and the worst headache she has ever had. She has occasional migraines but is normally fit and well. She drinks 10 units a week and has smoked 10 cigarettes a day for 20 years. Neurological examination is normal. What is the most appropriate initial investigation?

A CT head scan with contrast

B CT head scan without contrast

C Lumbar puncture

D MRI head scan

E None required

Mr Scott is a 74 year old man who has presented to A&E at 2:30pm with confused speech and right arm weakness. His wife Doris left him well that morning at 9am and found him this way when she returned at 1:30pm from the shops. He has Hypertension for which he takes Bendroflumethiazide 2.5mg one daily. On neurological examination he appears to have receptive and expressive dysphasia and has right arm weakness with 3/5 power on the MRC scale in all muscle groups. CT head shows an infarct in the distribution of the left middle cerebral artery. What is the most appropriate initial management?

A Alteplase

B 75mg Aspirin

C 300mg Aspirin

D 75mg Clopidogrel

E 300mg Clopidogrel

A 62 year old lady presents with dizziness. She describes attacks of feeling like the room is rotating and she feels unsteady on her feet. This often occurs when she turns her head whilst walking and she finds she needs to sit down. The attacks last a few minutes then settle down. She has not noticed any changes to her hearing or tinnitus. What is the most appropriate next step to investigate this lady’s diagnosis?

A Dix-Hallpike manoeuvre

B Epley manoeuvre

C Lying and standing blood pressure

D MRI brain

E Romberg’s test