AMK head pathologies pt 1 :)

A 65 years old man is brought to the GP by his wife. The wife complains that over the past few months, her husband has show a step-wise deterioration in his cognitive ability. On checking his records, the man has a past medical history of hypertension and myocardial infarction. He smoked 20 cigarettes in a day and has a BMI of 31. Based on his history, what is the most likely diagnosis for his reduction in cognitive ability?

A 53 years old man is brought to the GP by his daughter for a health review. The man experiences progressive cognitive decline that interferes with his normal social functioning. Also, the daughter complains that her dad experiences visual hallucination. On examination, you notice that he is rigid and has resting tremors. What is the most likely diagnosis?

Neurosurgeons should be involved at an early stage" with patients in a [blank_start]coma[blank_end] if [blank_start]raised[blank_end] [blank_start]intracranial[blank_end] [blank_start]pressure[blank_end] is suspected

Which of these is not a symptom of subarachnoid hemorrhage?

What is sub-arachnoid hemmorhages associated with?

Antiplatelet medications: [blank_start]Aspirin[blank_end] irreversibly inhibiting COX enzymes and prevents [blank_start]thromboxane[blank_end] [blank_start]A2[blank_end] from activating. Clopidogrel inhibits [blank_start]ADP[blank_end] receptors.

[blank_start]Postural[blank_end] tremor is absent at rest but present on [blank_start]maintained[blank_end] posture, such as when the arms are outstretched) and may persist (but is not worse) on movement. Causes: [blank_start]Benign[blank_end] essential tremor

Parkinsonism is a causitive example of a resting tremor like how a cerebellar lesion is for intention tremor.s

Global dysphasia is when both comprehension and expression is compromised.

When there is a non-dominant (right) hemisphere lesion, visuospatial disturbances may occur.

This 68-year-old male presented with a chief complaint of facial drooping and a painful rash. What is the most likely diagnosis?

A patient presents with loss of sensation and strength on the right side of their face and their right upper limb. The patient can still wrinkle their forehead. What is the most likely diagnosis?

A 65 years old man who was previously diagnosed with lung cancer presents to the ED. He complains that he can’t sweat on the left side of his face. Using his presentation and the image shown below, what is the most likely diagnosis?

A 34 years old woman visits the ED due to the sudden onset of the following symptoms: vertigo, nausea and vomiting, frequent falls to the right, shaking of right arm when doing tasks, nystagmus and slurring of speech. Examination showed right dysmetria and right dysdiadochokinesia. Which of the following is the most likely cause?

thrombotic and embolic are both types of ischemic strokes

intracerebral and subarachnoid hemorrhages can lead to hemorrhagic stroke

What is true regarding stroke?

Stroke depending on vasculature: Anterior Cerebral Artery: Contralateral [blank_start]hemiparesis[blank_end] and sensory loss in the [blank_start]lower[blank_end] extremity. Middle Cerebral Artery: Contralateral [blank_start]hemiparesis[blank_end] and sensory loss in the [blank_start]upper[blank_end] extremity. Contralateral [blank_start]homonymous[blank_end] [blank_start]hemianopia[blank_end] (blindness over half the field of vision.) and [blank_start]aphasia[blank_end] (problems using language correctly.) Posterior Cerebral Artery: Contralateral [blank_start]homonymous[blank_end] [blank_start]hemianopia[blank_end] with macular sparing. Visual [blank_start]agnosia[blank_end] (inability to interpret sensations and hence to recognize things)

Management: Ischemic: 1. [blank_start]Aspirin[blank_end] 300mg + [blank_start]antiplatelet[blank_end] therapy for 14 days If the patient presents within 4.5 hours of the stroke symptoms, [blank_start]thrombolysis[blank_end] therapy with [blank_start]alteplase[blank_end] should be given (assuming no contraindications) Secondary prevention: clopridogrel Hemorrhagic: 1. Neurosurgical consultation 2. [blank_start]Supportive[blank_end] management. For example, stop anticoagulants (e.g. warfarin). 3. Lower patient’s [blank_start]blood[blank_end] [blank_start]pressure[blank_end] acutely.

Ramsey Hunt Syndrome is caused by [blank_start]herpes[blank_end] [blank_start]zoster[blank_end] virus presents as [blank_start]facial[blank_end] [blank_start]nerve[blank_end] palsy, painful blistering rash on face and in [blank_start]ear[blank_end], and loss of [blank_start]anterior[blank_end] 2/3 taste Treat with oral [blank_start]acyclovir[blank_end] and prednisolone

Bell's palsy affects upper motor neurons.

[blank_start]Bell’s[blank_end] [blank_start]palsy[blank_end] is due to viral infection, which causes swelling and compression of the facial nerve.

Most recover spontaneously from Bell's palsy within a few weeks.

[blank_start]Bell's[blank_end] [blank_start]Palsy[blank_end] is muscle weakness or total loss of the ability to move one side of the face and a change in taste. TRTMENT: [blank_start]prednisolone[blank_end]

A TIA is anything that is under 24 hrs

If TIA: 1. Give [blank_start]300[blank_end] mg aspirin immediately 2. ABCD2 for further management: A age B [blank_start]blood[blank_end] [blank_start]pressure[blank_end] C [blank_start]clinical[blank_end] features D [blank_start]duration[blank_end] of symptoms or [blank_start]diabetes[blank_end]

Further management of TIAs: ABCD2 ≥ 4: Specialist assessment and investigation within [blank_start]24[blank_end] [blank_start]hours[blank_end]. Secondary prevention (i.e. clopidogrel) introduced as soon as the diagnosis is confirmed. ABCD2 ≤ 3: Specialist assessment within [blank_start]1[blank_end] [blank_start]week[blank_end]. If vascular territory or pathology is uncertain, refer for brain imaging ([blank_start]MRI[blank_end]). Secondary prevention (i.e. clopidogrel) introduced as soon as the diagnosis is confirmed. [blank_start]Crescendo[blank_end] TIAs should be treated as being at high risk of stroke, even if the ABCD2 ≤ 3. Use management criteria of ABCD2 ≥ 4

Carotid endarectomy is associated with the glossopharyngeal n

Some people who have had a TIA have [blank_start]narrowing[blank_end] of the carotid artery that may require [blank_start]surgical[blank_end] intervention. Carotid imaging ([blank_start]Carotid[blank_end] [blank_start]Doppler[blank_end]) is required to define the extent of carotid artery narrowing. Recommend if patient has suffered stroke or TIA in the carotid territory and is not severely disabled.

‘A 72 year old man presents to his GP with issues with his speech. He talks fluently and articulates well, all at a normal rate. However on closer listening, you note he uses many seemingly made up words, and doesn’t seem to employ grammar of any kind. He also struggles to repeat sentences and phrases back to you’. What is the most likely anatomical location of the lesion?

A 65 years old man is brought to the GP by his wife. The wife complains that over the past few months, her husband has show a step-wise deterioration in his cognitive ability. On checking his records, the man has a past medical history of hypertension and myocardial infarction. He smoked 20 cigarettes in a day and has a BMI of 31. Based on his history, what is the most likely diagnosis for his reduction in cognitive abilit

A 53 years old man is brought to the GP by his daughter for a health review. The man experiences progressive cognitive decline that interferes with his normal social functioning. Also, the daughter complains that her dad experiences visual hallucination. On examination, you notice that he is rigid and has resting tremors.

Which of the following is false about the blood supply of the brain

A 34 years old woman visits the ED due to the sudden onset of the following symptoms: vertigo, nausea and vomiting, frequent falls to the right, shaking of right arm when doing tasks, nystagmus and slurring of speech. Examination showed right dysmetria and right dysdiadochokinesia. Which of the following is the most likely cause?

A patient presents with loss of sensation and strength on the right side of their face and their right upper limb. The patient can still wrinkle their forehead. What is the most likely diagnosis?

A patient has a lesion on the right optic tract. What would be the presenting complaint of the patient?

A 58 year old male has recently been diagnosed with acromegaly after noticing his shoe size started increasing and he had numbness in his fingers after typing at work. Given this diagnosis, what is the most likely visual field defect he will be experiencing?

A 65 year old women presents to the GP with a one week history of severe knife like stabbing and electric shock pains down the left side of her face. She mentioned that they start when she washes and last for about 10 seconds.Given the likely diagnosis what is the most suitable 1st line treatment?

A 68-year-old male presented with a chief complaint of facial drooping and a painful rash. What is the most likely diagnosis?

A 72 year old man with a history of previous stroke comes to the clinic for a checkup. On examination you find that when the patient sticks his tongue out, it deviates to the left. When the left posterior pharynx is sitmulated with a swab, the uvula deviates to the right. Which structure has been affected?

You are a GP on a home visit to a 4 year old child who has become ill.She is drowsy, listless, complains of a headache and feels very hot. Her mum gave her some ‘Calpol’ and got her ready for bed. She did not settle and has started to vomit.Kernig’s sign is positiveWhich of the following is the most suitable management?

A patient presents to the ED with fever, headache, neck stiffness and photophobia. On examination, you find a non-blanching rash on her abdomen. You assess her ‘ABCDE’. Given her presentation and examination findings, you highly suspect bacterial septicaemia.What is the most appropriate next step in this patient’s management?

You are asked to interpret CSF for another patient who you know little about. The fluid appears cloudy. CSF analysis reveals: Raised protein; high neutrophils; reduced glucose.What is the likely cause of this patient’s illness?

A 28-year-old junior doctor has been complaining of a headache for the last 24 hours. It started gradually, intensifying slowly and involving the entire cranium, but over the last couple of hours she has noticed that turning her head is uncomfortable. She feels generally unwell and prefers to lie in a dark room. Her boyfriend has noticed that she seems irritable. On examination, she exhibits photophobia and there is neck stiffness. There is no papilloedema. Close examination of her skin reveals no rashes. A lumbar puncture (LP) reveals raised protein, normal glucose and high lymphocytosis. 

A 54 year old woman who smokes 10 cigarettes a day and is also hypertensive presents to the hospital because she has a sudden onset headache, which she describes as her worst headache ever. She describes the headache to be like a kick to the back of the head. She has neck stiffness but she is not pyrexic or photophobic. What is the most likely diagnosis?

You shine a light into one eye, you get contralateral pupil constriction but no ipsilateral constriction. Where is the lesion?

You shine a light into an eye and get no response bilaterally. Where is the lesion?