Neurology1. A 34-year-old piano teacher attends after waking with a drooping left mouth. She cannot wrinkle the left forehead or close the left eye fully. Taste is altered on the left of the tongue. There is no limb weakness, no rash in the ear canal, and no other cranial-nerve deficit. Which pattern does this describe?A. Lower motor neurone facial (VII) palsy affecting the whole hemiface including the foreheadB. Upper motor neurone facial weakness from a lacunar strokeC. Isolated trigeminal motor neuropathyD. Oculomotor (III) palsyCheck
Neurology2. A 68-year-old man develops sudden left facial droop, left arm weakness and slurred speech in the waiting room. Symptoms began 20 minutes ago and are persisting. What is the most appropriate next step?A. Call 999 for suspected strokeB. Give aspirin 300 mg and observe for 1 hourC. Book a TIA clinic slot for the next working dayD. Arrange a routine GP follow-up after weekendCheck
Neurology3. A 38-year-old man has nightly strictly unilateral peri-orbital attacks lasting 45 minutes with tearing and a blocked nostril on the same side. He paces the room. What is the most appropriate acute treatment to offer for an attack? Select TWO correct statements.Select all that apply.A. Most appropriate: High-flow 100 percent oxygen via a non-rebreather maskB. The following is not the most appropriate next step: Oral sumatriptan 50 mg at onsetC. Most appropriate: Codeine phosphate 30 mg as requiredD. Most appropriate: Propranolol 80 mg modified-release dailyCheck
Neurology4. A 29-year-old Group 1 car driver had a first unprovoked generalised seizure yesterday, witnessed, with lateral tongue biting. He has recovered. What must you advise about driving?A. He may drive if a relative is in the carB. Stop driving immediately and notify DVLAC. Drive as usual until the first-fit clinic writesD. Stop driving for 7 days then resume if wellCheck
Neurology5. A 44-year-old man with acute lumbar disc pain develops bilateral sciatica, numbness in the saddle area, and painless urinary retention. What is the most appropriate action?A. Urgent outpatient MRI within 2 weeksB. Trial of high-dose ibuprofen and safety-nettingC. Same-day emergency referral for urgent MRID. Routine musculoskeletal physiotherapy referralCheck
Neurology6. A 38-year-old pregnant woman has nocturnal tingling in the thumb, index and middle fingers that wakes her and is eased by shaking the hand. Thenar power is normal. What is the most appropriate initial management?A. Urgent brain MRI for sensory TIAB. Start carbamazepine for trigeminal neuralgiaC. Nocturnal wrist splints and obstetric adviceD. Immediate carpal tunnel decompression this weekCheck
Neurology7. A 35-year-old woman reports drooping eyelids and double vision that are minimal in the morning and marked by evening. Ice on the eyelid temporarily improves the ptosis. Limb sensation is normal. What is the most likely diagnosis? The most appropriate action is: Myasthenia gravisTRUE. TrueFALSE. FalseCheck
Neurology8. A 24-year-old woman with BMI 38 kg/m2 has headaches and transient visual obscurations. Fundoscopy shows bilateral papilloedema. Blood pressure is 118/74 mmHg. What is the most appropriate next step? Select TWO correct statements.Select all that apply.A. Most appropriate: Same-day ophthalmology or neurology assessmentB. The following is not the most appropriate next step: Reassure and trial propranolol for migraineC. Most appropriate: Start carbamazepine for atypical neuralgiaD. Most appropriate: Routine optician review in 3 monthsCheck
Neurology9. A 45-year-old woman has an urge to move her legs in the evening, worse at rest, relieved by walking, with crawling sensations. Examination is normal. What blood test is most useful before drug treatment?A. Serum ferritin (and iron studies as indicated)B. Serum copperC. Acetylcholine receptor antibodiesD. Serum ACECheck
Neurology10. A 59-year-old man with type 2 diabetes has gradual burning in both feet, worse at night, with reduced pinprick to mid-shin. Ankle jerks are reduced. What is the most likely diagnosis? The most appropriate action is: Distal symmetrical diabetic polyneuropathyTRUE. TrueFALSE. FalseCheck