CERTS® Poolbook
Pool - SCE Neurology Web Questions
76 items
23/06/2017 07:58
Page 1 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16095.2
1.
An 18-year-old woman presented with a 6-month history of blurred vision. Her history
included heart block, requiring a permanent pacemaker. She also had mild learning
difficulties.
Examination showed a complete external ophthalmoplegia, with normal pupillary
reactions. There was mild finger–nose ataxia and absent lower limb reflexes.
What is the most likely diagnosis?
A
congenital myasthenia
B
hypothyroidism
C
Miller Fisher syndrome
D
mitochondrial disease
E
myotonic dystrophy
Metadata
Domain=SCE Items
Topic=B.Clinical science\5.Genetics\3.Mitochondrial DNA disorders
Objective=n/a
Item Status=Dataloaded
Keywords=17210
Custom Item Label=17210
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HX3
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16866.2
2.
A 30-year-old woman with MELAS attended the outpatient clinic and asked whether any
of her children would be affected by the condition.
Genetic analysis showed that she carried the mitochondrial DNA 3243 mutation.
What proportion of her children are likely to be affected?
A
all
B
all daughters
C
all sons
D
half
E
not predictable
Metadata
Domain=SCE Items
Topic=B.Clinical science\5.Genetics\3.Mitochondrial DNA disorders
Objective=n/a
Item Status=Dataloaded
Keywords=3416
Custom Item Label=3416
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Genetics/Congenital
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HU
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
Page 3 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16888.2
3.
A 31-year-old man presented with vertigo and left-sided ataxia of sudden onset. He
gave a history of pain and tingling in his limbs for many years during childhood and
adolescence, for which no cause had been found. His mother’s brother had died at the
age of 41 from renal failure.
On examination, urinalysis showed protein 1+.
Investigations:
full blood count
normal
erythrocyte sedimentation rate
13 mm/1st h (<15)
urea and electrolytes
normal
fasting plasma glucose
3.7 mmol/L (3.0–6.0)
MR scan of brain
left-sided cerebellar infarction
ECG
left ventricular hypertrophy
What is the most likely unifying diagnosis?
A
amyloidosis
B
Fabry's disease
C
MELAS
D
polyarteritis nodosa
E
von Hippel–Lindau disease
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Metadata
Domain=SCE Items
Topic=D.Endocrinology and metabolic medicine\17.Lysosomal storage disorders\2.Fabry's
disease
Objective=n/a
Item Status=Dataloaded
Keywords=3440
Custom Item Label=3440
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Genetics/Congenital
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cerebrovascular dise
SCE Topics Neurology=HG
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16956.2
4.
A 27-year-old woman was referred following a liver biopsy for unexplained abnormal
liver function tests. She had also become withdrawn and clumsy.
On examination, she was grimacing, drooling and dysarthric. Her mini-mental state
examination was 24/30. She walked with dystonic posturing of her right arm and was
ataxic.
Copper studies were performed.
What pattern of results is most likely to confirm the diagnosis?
A
B
C
D
E
serum copper
high
high
low
low
low
urinary copper
high
low
high
low
low
liver copper
low
high
high
high
low
A
B
C
D
E
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Pool - SCE Neurology Web Questions
Metadata
Domain=SCE Items
Topic=E.Gastroenterology\10.Liver disorders\6.Cirrhosis\4.Wilson's disease
Objective=n/a
Item Status=Dataloaded
Keywords=3563
Custom Item Label=3563
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Extra Text:_low
_low
_low
_
_
[27/09/2012 16:47:06]
Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HO
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I15968.2
5.
A 30-year-old man from Zimbabwe presented with a 1-year history of numbness on the
left side of his body. He was HIV positive and was taking antiretroviral treatment.
Examination was normal.
Investigations:
MR scan of brain (axial FLAIR)
see image
serum hydatid antibody (enzyme-linked
immunosorbent assay)
negative
What is the most likely diagnosis?
A
glioma
B
hydatid disease
C
neurocysticercosis
D
toxoplasmosis
E
tuberculosis
Metadata
Domain=SCE Items
Topic=E.Gastroenterology\10.Liver disorders\9.Infections involving the liver\2.Hydatid
disease
Objective=n/a
Item Status=Dataloaded
Keywords=13464
Custom Item Label=13464
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
Page 8 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Interpretation
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HI
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16028.2
6.
A 76-year-old man developed unsteadiness when trying to walk 2 weeks after
undergoing right hemicolectomy for carcinoma. His postoperative course had been
complicated by severe Gram-negative sepsis for which he had required assisted
ventilation and treatment with broad-spectrum antibiotics. At one stage, trough
gentamicin concentration had been in the toxic range.
On examination, a head-thrust test was normal. He was able to stand independently,
but swayed. He had a broad-based gait and could not tandem walk. Romberg’s test was
negative.
What is the most likely diagnosis?
A
acute alcohol withdrawal
B
cerebellar stroke
C
gentamicin toxicity
D
paraneoplastic cerebellar degeneration
E
subacute combined degeneration of the cord
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease\1.Cerebral infarction
Objective=n/a
Item Status=Dataloaded
Keywords=13529
Custom Item Label=13529
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Do not use with 13527 or 13528
[27/09/2012 16:47:23]
Extra Text:
Do not use with 13527 or 13528
[27/09/2012 16:47:06]
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Page 10 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cerebrovascular dise
SCE Topics Neurology=HG
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16027.2 - 13528
(Dataloaded)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16026.1 - 13527
(Dataloaded)
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16409.4
7.
In a population of 100 000 people in a UK town, what is the closest approximation to the
number of new cases of stroke occurring in a year?
A
20
B
50
C
75
D
150
E
500
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease\1.Cerebral infarction
Objective=n/a
Item Status=Dataloaded
Keywords=23383
Custom Item Label=23383
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cerebrovascular dise
SCE Topics Neurology=HG
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I15937.2
8.
A 60-year-old man of no fixed abode was found ‘collapsed’ on the street by a passerby.
An ambulance was called and he was taken to the emergency department.
On examination, his GCS was 9 (M3, V2, E4). He had numerous spider naevi and
palmar erythema.
Investigations:
serum sodium
serum bicarbonate
random plasma glucose
128 mmol/L (137–144)
19 mmol/L (20–28)
3.2 mmol/L
non-contrast CT scan of head (axial section)
see image
What is the most likely diagnosis?
A
cerebral venous sinus thrombosis
B
hepatic encephalopathy
C
malignant glioma
D
pneumococcal meningitis
E
subarachnoid haemorrhage
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease\3.Subarachnoid haemorrhage
Objective=n/a
Item Status=Dataloaded
Keywords=13419
Custom Item Label=13419
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurophysiology, neu
SCE Topics Neurology=HX10
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I15993.2
9.
A 59-year-old man presented after a 25-minute transient ischaemic attack that had
manifested as left arm and leg weakness. He had previously been well.
On examination, his pulse was 72 beats per minute and regular, his BP was
135/84 mmHg and his heart sounds were normal. Neurological examination was
normal.
What is the best estimate of his risk of a stroke over the next 48 hours?
A
1%
B
4%
C
8%
D
15%
E
20%
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease\4.Transient ischaemic attacks
Objective=n/a
Item Status=Dataloaded
Keywords=13490
Custom Item Label=13490
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Prognosis
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cerebrovascular dise
SCE Topics Neurology=HG
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I17302.4
10.
A 26-year-old woman presented after sustaining a head injury following a fall down
stairs. Thirty minutes later, she became increasingly drowsy.
On examination, her GCS was 6 (E1, V1, M4).
What best describes her motor response?
A
abnormal flexion
B
extension to pain
C
flexion to pain
D
localises pain
E
obeys commands
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease\5.Extradural haematoma
Objective=n/a
Item Status=Dataloaded
Keywords=8044
Custom Item Label=8044
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Adolescent medicine
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HC
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I17316.2
11.
A 45-year-old man presented with a 4-day history of fever, headache and neck stiffness.
On examination, he was pyrexial (39.0°C). His GCS was 15. Kernig’s sign was positive.
There were no focal neurological signs.
Investigations:
cerebrospinal fluid:
opening pressure
total protein
glucose
cell count
lymphocyte count
neutrophil count
240 mmH2O (120–250)
1.2 g/L (0.15–0.45)
1.2 mmol/L (3.3–4.4)
150/µL (≤5)
10/µL (≤3)
140/µL (0)
Gram stain
Gram-positive coccobacillus
Which organism is the most likely causative agent?
A
Escherichia coli
B
Haemophilus influenzae
C
Listeria monocytogenes
D
Neisseria meningitidis
E
Streptococcus pneumoniae
Metadata
Domain=SCE Items
Topic=H.Neurology\10.CNS infections\1.Meningitis\1.Bacterial meningitis
Objective=n/a
Item Status=Dataloaded
Keywords=8058
Custom Item Label=8058
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Interpretation
Groups=Path/Hist/Micro/Viro
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HI
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I17437.2
12.
A 35-year-old Asian man was admitted in a coma. He was separated from his family
and living rough. No history was available, other than the suggestion that he was a
heavy drinker.
On examination, he had periodic breathing. His GCS was 3. He was swiftly intubated
and received mechanical ventilation. After treatment with thiamine and glucose, there
was no change in his GCS.
Investigations:
random plasma glucose
4.9 mmol/L
cerebrospinal fluid:
total protein
glucose
cell count
lymphocyte count
2.4 g/L (0.15–0.45)
2.2 mmol/L (3.3–4.4)
12/μL (≤5)
12/μL (≤3)
Gram stain and acid-fast bacilli stain
negative
CT scan of head
enlarged ventricles
What is the most likely diagnosis?
A
cryptococcal meningitis
B
herpes simplex encephalitis
C
pneumococcal meningitis
D
sarcoidosis
E
tuberculous meningitis
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Pool - SCE Neurology Web Questions
Metadata
Domain=SCE Items
Topic=H.Neurology\10.CNS infections\1.Meningitis\3.Tuberculous meningitis
Objective=n/a
Item Status=Dataloaded
Keywords=8427
Custom Item Label=8427
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Not to be used with 8428
[27/09/2012 16:47:23]
Extra Text:
Not to be used with 8428
[27/09/2012 16:47:06]
Dimensions
Groups=Diagnosis
Groups=Interpretation
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HI
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I17438.2 - 8428 (Dataloaded)
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16708.2
13.
A 30-year-old Brazilian woman gave a 2-year history of worsening low back discomfort
that radiated into her legs, with leg cramps and urinary urgency and incontinence. She
had moved to the UK 3 years previously.
Examination showed a mild spastic paraparesis. Her CD4 lymphocyte count was
normal. An MR scan of brain was normal, MR spine showed patchy increased T2 signal
mainly in the thoracic cord. Cerebrospinal fluid examination showed a lymphocytosis of
20 cells/mm3, raised IgG and the presence of unpaired oligoclonal bands.
What is the most likely diagnosis?
A
HIV vacuolar myelopathy
B
human T-lymphotropic virus type I associated myelopathy
C
multiple sclerosis
D
neurosyphilis
E
subacute combined degeneration of the cord
Metadata
Domain=SCE Items
Topic=H.Neurology\11.Myelopathy/radiculopathy
Objective=n/a
Item Status=Dataloaded
Keywords=27866
Custom Item Label=27866
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Immunology
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HI
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I15890.2
14.
A 35-year-old woman developed bilateral optic neuritis with partial recovery. An
MR scan of brain was normal.
One year later, she developed paraparesis and incontinence. She was given
intravenous methylprednisolone followed by oral prednisolone, but continued to
deteriorate.
Investigations:
erythrocyte sedimentation rate
7 mm/1st h (<20)
antinuclear antibodies
positive
anti-aquaporin 4 (NMO-IgG) antibodies
negative
MR scan of spine
high-signal lesion from C6–T10
cerebrospinal fluid:
white cell count
oligoclonal bands
12/µL (5)
negative
What is the most likely diagnosis?
A
acute disseminated encephalomyelitis
B
multiple sclerosis
C
neuromyelitis optica spectrum disorder
D
Sjögren’s syndrome
E
systemic lupus erythematosus
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Pool - SCE Neurology Web Questions
Metadata
Domain=SCE Items
Topic=H.Neurology\12.Demyelinating disorders
Objective=n/a
Item Status=Dataloaded
Keywords=13369
Custom Item Label=13369
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HK
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
Page 25 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Item I16050.2
15.
A 39-year-old woman with secondary progressive multiple sclerosis was able to walk
60 m on level ground with bilateral support.
What is her estimated Expanded Disability Status Scale score?
A
5.0
B
5.5
C
6.0
D
6.5
E
7.0
Metadata
Domain=SCE Items
Topic=H.Neurology\12.Demyelinating disorders\1.Multiple sclerosis
Objective=n/a
Item Status=Dataloaded
Keywords=13844
Custom Item Label=13844
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Rehabilitation
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HK
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Item I16329
16.
An 18-year-old man presented with exercise-related muscle cramps. He described a
‘second wind’ phenomenon during sporting activities. A muscle biopsy was performed.
What histopathological stain is most likely to show the underlying diagnosis?
A
cytochrome oxidase
B
Gomori’s trichrome
C
haematoxylin and eosin
D
periodic acid–Schiff
E
Sudan black
Metadata
Domain=SCE Items
Topic=H.Neurology\13.Myopathy
Objective=n/a
Item Status=Dataloaded
Keywords=20739
Custom Item Label=20739
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Path/Hist/Micro/Viro
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurophysiology, neu
SCE Topics Neurology=HX7
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Item I17289.2
17.
A 38-year-old man gave a 12-year history of progressive lower limb weakness. Until his
mid-twenties he had played squash to club standard. There was no family history of
neurological disorders.
On examination, cranial nerve function was normal. The upper limbs were normal, with
no scapular winging. There was moderate bilateral weakness of quadriceps and hip
flexors and mild weakness of ankle dorsiflexors. Lower limb reflexes were absent but
plantar responses were flexor. Sensory examination was normal.
Investigations:
serum creatine kinase
5000 U/L (24–195)
What is the most likely diagnosis?
A
Becker’s muscular dystrophy
B
dysferlinopathy
C
Emery–Dreifuss muscular dystrophy
D
facioscapulohumeral dystrophy
E
hereditary motor and sensory neuropathy
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Metadata
Domain=SCE Items
Topic=H.Neurology\13.Myopathy\1.Muscular dystrophy\3.Limb girdle dystrophy
Objective=n/a
Item Status=Dataloaded
Keywords=8030
Custom Item Label=8030
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Not to be used with 8031
[27/09/2012 16:47:23]
Extra Text:
Not to be used with 8031
[27/09/2012 16:47:06]
Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HU
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Item I16975.2
18.
A 52-year-old woman presented with generalised muscle pains of 6 months’ duration.
She had been taking amlodipine, irbesartan, atorvastatin and gliclazide for
approximately 1 year.
Neurological examination was normal.
Investigations:
serum creatine kinase
293 U/L (24–170)
What is the most likely cause of her myalgia?
A
atorvastatin toxicity
B
fibromyalgia
C
gliclazide toxicity
D
irbesartan toxicity
E
polymyositis
Metadata
Domain=SCE Items
Topic=H.Neurology\13.Myopathy\6.Drug-induced myopathy
Objective=n/a
Item Status=Dataloaded
Keywords=3583
Custom Item Label=3583
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
Page 30 of 124
CERTS® Poolbook
Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Pharmacology
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HU
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
Page 31 of 124
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Pool - SCE Neurology Web Questions
Item I16798.2
19.
A 62-year-old man with motor neurone disease reported a 6-month history of
progressive dysphagia. He had lost 15 kg in weight. He remained ambulant.
On examination, his vital capacity was 0.9 L.
What is the most appropriate intervention for his dysphagia?
A
long-term fine-bore nasogastric feeding
B
oesophageal myomectomy
C
percutaneous endoscopic gastrostomy
D
radiologically inserted gastrostomy
E
total parenteral nutrition
Metadata
Domain=SCE Items
Topic=H.Neurology\14.Motor neurone disease
Objective=n/a
Item Status=Dataloaded
Keywords=3275
Custom Item Label=3275
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Neurology Examination 2011 Item 3275
pbs: 0.44
JM: Had MND been diagnosed before he developed dysphagia? If not, I suggest the diagnosis
should be stated in a final sentence of the stem.
Neurology Examination 2010 Item 3275
pbs: 0.47
[27/09/2012 16:47:23]
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Dimensions
Groups=Chronic Management
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Disorders of the spi
SCE Topics Neurology=HN
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16728.2
20.
A 25-year-old woman presented with a history of intermittent dysphagia. She was
unable to hang out more than four items of washed clothing to dry without resting and
had experienced breathlessness over the past 6 months.
On examination, she had neck flexor weakness and weak proximal arm muscles. Her
sensory examination and tendon reflexes were normal.
Investigations:
serum corrected calcium
serum phosphate
serum creatine kinase
2.60 mmol/L (2.20–2.60)
0.8 mmol/L (0.8–1.4)
250 U/L (24–170)
serum thyroid-stimulating hormone
serum free T4
0.6 mU/L (0.4–5.0)
23.0 pmol/L (10.0–22.0)
What is the most likely diagnosis?
A
Lambert–Eaton myasthenic syndrome
B
myasthenia gravis
C
polymyositis
D
sarcoid myopathy
E
thyrotoxic myopathy
Metadata
Domain=SCE Items
Topic=H.Neurology\15.Neuromuscular junction disorders\1.Myasthenia gravis
Objective=n/a
Item Status=Dataloaded
Keywords=3015
Custom Item Label=3015
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HL
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17393.2
21.
A 74-year-old man gave a 6-week history of gradually worsening weakness in both legs.
He could walk unaided but had difficulty climbing stairs. He had also reported aching of
his thighs, tingling in his feet and dryness of his mouth. He had developed a dry cough
2 months earlier, but that had improved after a course of antibiotics. His only medication
was simvastatin 40 mg at night for hypercholesterolaemia.
On examination, there was mild bilateral ptosis, mild bilateral weakness of his shoulder
girdle and more severe weakness of both legs affecting hip flexion and extension, and
knee flexion. He was unable to rise unaided from squatting. Reflexes were absent and
the plantar responses were flexor. Sensory examination was normal.
Investigations:
serum creatine kinase
250 U/L (24–195)
What is the most likely diagnosis?
A
Guillain–Barré syndrome
B
inclusion-body myositis
C
Lambert–Eaton myasthenic syndrome
D
myasthenia gravis
E
statin-associated myopathy
Metadata
Domain=SCE Items
Topic=H.Neurology\15.Neuromuscular junction disorders\2.Lambert-Eaton syndrome
Objective=n/a
Item Status=Dataloaded
Keywords=8261
Custom Item Label=8261
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Geriatric
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HS
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16366.2
22.
A 75-year-old woman complained of weakness of her left leg. Forty-eight hours
previously she had been given a spinal anaesthetic for a left total hip replacement. The
operation note and anaesthetic chart suggested no untoward events during the
operation.
On examination, neurological signs were confined to the left leg. There was severe
weakness of flexion of the knee, dorsiflexion, plantarflexion, inversion and eversion of
the ankle, extension of the great toe and flexion and extension of the toes. The knee
jerk was normal but the ankle jerk was absent. There was diminished sensation to
pinprick over the calf, the sole and dorsum of the foot extending up the anterolateral
aspect of the shin to just below the tibial tuberosity.
What is the most likely diagnosis?
A
common peroneal nerve lesion
B
diabetic amyotrophy
C
L5/S1 disc prolapse
D
sciatic nerve lesion
E
spinal extradural haematoma
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\1.Peripheral neuropathy\1.Mononeuropathies
Objective=n/a
Item Status=Dataloaded
Keywords=23334
Custom Item Label=23334
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16740.2
23.
A 51-year-old-woman presented with weakness of her right hand, which had developed
2 days after receiving a flu vaccine in her left arm. For 24 hours after the immunisation,
she had felt unwell with mild fever, right-sided neck pain and muscle ache. She had a
history of hypertension, for which she was taking bendroflumethiazide 5 mg daily.
On examination, she had right finger drop with loss of thumb extension. Power was
otherwise normal. There was no sensory deficit. All tendon reflexes were symmetrical
and brisk. Her right plantar response was equivocal and left plantar response was
flexor.
What is the most likely cause of her hand weakness?
A
C7 radiculopathy
B
left hemispheric lacunar infarct
C
posterior interosseous nerve palsy
D
radial nerve palsy
E
thoracic outlet syndrome
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\1.Peripheral neuropathy\1.Mononeuropathies
Objective=n/a
Item Status=Dataloaded
Keywords=3213
Custom Item Label=3213
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Dimensions
Groups=Anatomy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HS
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16367.2
24.
A 36-year-old woman presented with a 2-year history of worsening weakness and
cramps in her hands.
On examination of the upper limbs, there was no wasting. Occasional fasciculations
were seen in the intrinsic hand muscles. There was marked weakness, particularly of
finger extension in the left hand. Tendon reflexes were diminished. Sensation was
normal.
Investigations:
serum creatine kinase
MR scan of cervical spine
300 U/L (24–170)
normal
cerebrospinal fluid:
total protein
0.60 g/L (0.15–0.45)
What is the most likely diagnosis?
A
amyotrophic lateral sclerosis
B
chronic inflammatory demyelinating polyradiculoneuropathy
C
inclusion body myositis
D
multifocal motor neuropathy
E
myasthenia gravis
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\1.Peripheral neuropathy\2.Mononeuritis multiplex
Objective=n/a
Item Status=Dataloaded
Keywords=23335
Custom Item Label=23335
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16546.3
25.
A 65-year-old man with multiple myeloma had a 6-week history of numbness of his chin.
On examination, there was sensory loss to pinprick over the right side of his chin,
extending 2.5 cm laterally from the midline and just involving his lower lip on the right
side.
Where is the most likely site of the lesion?
A
foramen lacerum
B
infraorbital foramen
C
jugular foramen
D
mental foramen
E
pons
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\2.Cranial neuropathies
Objective=n/a
Item Status=Dataloaded
Keywords=27600
Custom Item Label=27600
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Anatomy
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Management
SCE Topics Neurology=HH
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17472.2
26.
A 50-year-old man complained of double vision when reading a newspaper 1 week after
a minor head injury.
On examination, he had double vision maximal on looking down and to the left. The
peripheral (outer) image came from the right eye.
Which extraocular muscle is most likely to be affected?
A
left inferior oblique
B
left superior oblique
C
right inferior oblique
D
right inferior rectus
E
right superior oblique
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\2.Cranial neuropathies
Objective=n/a
Item Status=Dataloaded
Keywords=8464
Custom Item Label=8464
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I39930.2
27.
A 38-year-old woman, who was 30 weeks pregnant, presented with right-sided facial
weakness of 24 hours’ duration associated with pain behind her right ear.
On examination, there was right lower motor neurone facial weakness and she was
unable to close her right eye. There were no vesicles in the external auditory canal.
What is the most appropriate treatment?
A
aciclovir alone
B
aciclovir and prednisolone
C
no active intervention
D
physiotherapy
E
prednisolone alone
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\2.Cranial neuropathies
Objective=n/a
Item Status=Create Item
Keywords=31214
Custom Item Label=31214
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Acute management
Groups=Pregnancy
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Neurological disorde
SCE Topics Neurology=HW1
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16037.3
28.
A 42-year-old man was referred with a lifelong history of excessive daytime sleepiness,
sudden episodes of collapse resulting from loss of muscle tone, and episodes of sleep
paralysis.
What is the most appropriate diagnostic investigation?
A
cerebrospinal fluid hypocretin
B
HLA typing
C
multiple sleep latency test
D
overnight polysomnography
E
sleep-deprived sleep EEG
Metadata
Domain=SCE Items
Topic=H.Neurology\17.Sleep disorders\1.Narcolepsy
Objective=n/a
Item Status=Dataloaded
Keywords=13538
Custom Item Label=13538
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Investigations
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HC
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17216.3
29.
A 71-year-old woman gave a 3-month history of progressive weakness of her right leg,
urgency of micturition and lower thoracic back pain.
On examination, there was an asymmetric spastic paraparesis, worse in her right leg,
and impairment of pain and temperature sensation in her left leg.
What is the most likely diagnosis?
A
ependymoma
B
meningioma
C
myelitis
D
spinal arteriovenous malformation
E
syringomyelia
Metadata
Domain=SCE Items
Topic=H.Neurology\18.Tumours of CNS\1.Intracranial tumours\1.Benign intracranial
tumours\1.Meningioma
Objective=n/a
Item Status=Dataloaded
Keywords=4645
Custom Item Label=4645
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the spi
SCE Topics Neurology=HR
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16995.2
30.
A 58-year-old woman gave a 4-week history of increasing headaches and progressive
visual loss.
On examination, her visual acuities were 6/60 bilaterally. There were bilaterally swollen
optic discs, failure of abduction of the left eye, and the right sternocleidomastoid was
wasted. She was areflexic.
Investigations:
erythrocyte sedimentation rate
60 mm/1st h (<30)
random plasma glucose
4.8 mmol/L
MR scan of brain
normal
cerebrospinal fluid:
opening pressure
total protein
glucose
lymphocyte count
culture
270 mmH2O (120–250)
0.60 g/L (0.15–0.45)
2.6 mmol/L (3.3–4.4)
8/μL (≤3)
no growth
What is the most likely diagnosis?
A
giant cell arteritis
B
idiopathic intracranial hypertension
C
malignant meningitis
D
neurosarcoidosis
E
tuberculous meningitis
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Metadata
Domain=SCE Items
Topic=H.Neurology\18.Tumours of CNS\1.Intracranial tumours\2.Malignant
tumours\2.Secondary malignant tumours
Objective=n/a
Item Status=Dataloaded
Keywords=4279
Custom Item Label=4279
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Interpretation
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I15944.2
31.
A 24-year-old woman presented with a 6-week history of increasing anxiety and
insomnia. She was admitted to a psychiatric ward and a neurological opinion was
sought because she developed facial grimacing and generalised choreiform
movements. She had been given benzodiazepines but no neuroleptics.
On examination, she was mute. Her temperature was 37.8°C. She had choreiform
movements affecting her limbs and trunk. Reflexes were normal. There were no
pyramidal tract signs. There was no evidence of myoclonus.
Investigations:
MR scan of brain
normal
EEG
diffuse slow waves
cerebrospinal fluid
normal with negative oligoclonal
bands
A paraneoplastic syndrome was suspected.
What tumour is most likely to be associated with this syndrome?
A
breast carcinoma
B
lymphoma
C
ovarian teratoma
D
small cell tumour of lung
E
uterine leiomyoma
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Metadata
Domain=SCE Items
Topic=H.Neurology\19.Paraneoplastic syndromes
Objective=n/a
Item Status=Dataloaded
Keywords=13426
Custom Item Label=13426
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Interpretation
Groups=Malignancy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HL
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I45847.1
32.
A 66-year-old woman presented with a 10-day history of worsening dizziness, unsteady
gait and blurred vision. She had lost 5 kg in weight over the previous 4 months.
On examination, she had apparently random, rapid involuntary eye movements in all
directions of gaze. She had frequent myoclonic jerks and an unsteady gait.
Investigations:
anti-Ri (ANNA-2) antibodies
positive
What is the most likely site of underlying malignancy?
A
bladder
B
breast
C
colon
D
kidney
E
ovary
Metadata
Domain=SCE Items
Topic=H.Neurology\19.Paraneoplastic syndromes
Objective=n/a
Item Status=Create Item
Keywords=33355
Custom Item Label=33355
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Malignancy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HL
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17324.2
33.
A 23-year-old overweight woman with idiopathic intracranial hypertension had
undergone an MR scan of brain (with MR venography) that was normal, and lumbar
puncture that had normal cerebrospinal fluid constituents, but raised pressure. She was
dieting and had lost 5 kg in weight. She was taking acetazolamide 500 mg twice daily.
On examination, she had bilateral papilloedema with a visual acuity of 6/12 on the right
and 6/9 on the left. Over the following week her blind spots had increased further in
size, and there was now a centrocaecal scotoma in her right eye and peripheral visual
field constriction. A further lumbar puncture was performed, which again showed raised
pressure, but despite this, her vision continued to deteriorate.
What is the most appropriate next step in management?
A
add furosemide
B
daily lumbar punctures
C
gastroplication (banding)
D
intravenous corticosteroids
E
lumboperitoneal shunt
Metadata
Domain=SCE Items
Topic=H.Neurology\20.Benign intracranial hypertension
Objective=n/a
Item Status=Dataloaded
Keywords=8066
Custom Item Label=8066
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
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Dimensions
Groups=Chronic Management
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HJ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16758.3
34.
A 24-year-old man was admitted immediately after a head injury, which was
complicated by cerebrospinal fluid leakage from the nose.
What is the most appropriate initial management?
A
bed rest with head elevated
B
dural tear repair
C
initiate treatment with prophylactic antibiotics
D
lumbar drain insertion
E
nasal packing
Metadata
Domain=SCE Items
Topic=H.Neurology\22.Trauma\1.Head injury
Objective=n/a
Item Status=Dataloaded
Keywords=3232
Custom Item Label=3232
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Acute management
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Management
SCE Topics Neurology=HA
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16136.2
35.
A 63-year-old woman gave a 6-month history of difficulty standing when in church. After
prolonged standing, she would feel increasingly unsteady. Her symptoms were relieved
by sitting or walking.
Examination on the couch was normal.
What investigation is most likely to be helpful?
A
autonomic function tests
B
caloric testing
C
lower limb somatosensory evoked potentials
D
MR scan of brain
E
surface electromyography
Metadata
Domain=SCE Items
Topic=H.Neurology\5.Movement disorders
Objective=n/a
Item Status=Dataloaded
Keywords=20314
Custom Item Label=20314
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Not with 20312
[27/09/2012 16:47:23]
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Dimensions
Groups=Investigations
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Parkinsonism and mov
SCE Topics Neurology=HM
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16135.1 - 20313
(Dataloaded)
23/06/2017 07:58
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Item I16698.3
36.
A 77-year-old man presented with abnormal movements, first noted after a knee
replacement 3 years previously. His memory had deteriorated, his coordination had
become impaired and his speech had become unintelligible. He was the oldest of three
brothers. His father had died at the age of 64, and his mother at 73. He had no children.
On examination, there was generalised chorea, although mainly in his head and neck,
with pouting mouth movements. His speech was slurred, dysphonic and ‘explosive’. The
limb reflexes were brisk, and he was ataxic.
What is the most likely diagnosis?
A
chorea acanthocytosis
B
dentatorubral-pallidoluysian atrophy
C
Huntington’s disease
D
neuroferritinopathy
E
spinocerebellar ataxia type 17
Metadata
Domain=SCE Items
Topic=H.Neurology\5.Movement disorders\2.Huntington's disease
Objective=n/a
Item Status=Dataloaded
Keywords=27855
Custom Item Label=27855
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Parkinsonism and mov
SCE Topics Neurology=HM
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16699.2
37.
A 30-year-old man presented following a generalised tonic-clonic seizure. He had a
1-year history of abnormal movements and unsteadiness. He was aware of poor
memory. No other family members were affected. His father had died at the age of 60,
and his mother had died at the age of 63.
On examination, there was generalised chorea and occasional myoclonic jerks. His
speech was slurred. His limb reflexes were brisk, and he was ataxic.
Investigations:
genetic test for Huntington’s disease
negative
What is the most likely diagnosis?
A
benign hereditary chorea
B
chorea acanthocytosis
C
dentatorubral-pallidoluysian atrophy
D
Huntington’s disease-like 2
E
Wilson’s disease
Metadata
Domain=SCE Items
Topic=H.Neurology\5.Movement disorders\6.Chorea
Objective=n/a
Item Status=Dataloaded
Keywords=27856
Custom Item Label=27856
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Parkinsonism and mov
SCE Topics Neurology=HM
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16846.2
38.
A 54-year-old woman gave a 1-week history of recurrent dizziness and unsteadiness.
Her symptoms were worse when she first sat up in the morning. They had begun after a
road traffic accident. Her medical history included type 2 diabetes mellitus,
hypercholesterolaemia and hypertension. She smoked 30 cigarettes per day.
On examination, she appeared anxious. There were no focal neurological signs. A
CT scan of head was normal.
What is the most likely diagnosis?
A
benign paroxysmal positional vertigo
B
cervicogenic dizziness
C
perilymph fistula
D
vertebral artery dissection
E
vertebrobasilar insufficiency
Metadata
Domain=SCE Items
Topic=H.Neurology\6.Dizziness\1.Benign positional vertigo
Objective=n/a
Item Status=Dataloaded
Keywords=3394
Custom Item Label=3394
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16390.3
39.
A 44-year-old woman presented with a 7-year history of disturbed sleep. She was
unaware of any problem, but her husband reported that she sat up and rubbed her head
for 3–4 minutes, between three and ten times a night. Occasionally she would stand up.
She snored when lying on her back. Her father had late-onset epilepsy.
Examination was normal, as was her EEG.
What is the most likely diagnosis?
A
familial frontal lobe epilepsy
B
jactatio capitis nocturna
C
periodic limb movements of sleep
D
rapid eye movement sleep behaviour disorder
E
somnambulism
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy
Objective=n/a
Item Status=Dataloaded
Keywords=23364
Custom Item Label=23364
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I55428.3
40.
A 10-year-old boy presented with new-onset focal seizures, easily controlled with
antiepileptic drugs.
He had normal social, language and motor development until the age of 6, when his
parents thought he was becoming deaf because he stopped responding to their voices,
although he did respond to other auditory cues. Shortly after this, his language
regressed over a several-month period until he lost almost all speech. His other
cognitive functions remained intact.
What is the most likely diagnosis?
A
autism
B
Landau–Kleffner syndrome
C
Lennox–Gastaut syndrome
D
Rett syndrome
E
selective mutism
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy
Objective=n/a
Item Status=Create Item
Keywords=661227
Custom Item Label=661227
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Not with 661228 [15/04/2016 14:26:59]
23/06/2017 07:58
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Dimensions
Groups=Associated Features
Groups=Diagnosis
Groups=Paediatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurological disorde
SCE Topics Neurology=HX6
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55430 - 661228 (Create Item)
23/06/2017 07:58
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Item I55871.2
41.
A 54-year-old right-handed woman was being evaluated for epilepsy surgery. An
MR scan of brain showed left hippocampal sclerosis.
Which neuropsychological deficit is likely to be most prominent?
A
global memory impairment
B
poor executive function
C
poor verbal memory
D
poor visual memory
E
visuospatial deficits
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy
Objective=n/a
Item Status=Create Item
Keywords=661345
Custom Item Label=661345
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Anatomy
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HX9
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55873.1 - 661346 (Create
Item)
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Item I15983.4
42.
A 24-year-old woman presented following a tonic-clonic seizure 3 days post partum.
On examination, she was post-ictal, drowsy and confused, and complained of
headache. Her temperature was 37.3°C, her pulse was 80 beats per minute and her BP
was 168/95 mmHg.
Investigations:
MR scan of brain (axial T2 and coronal T1)
see images
What is the most appropriate immediate treatment?
A
aciclovir
B
aspirin
C
heparin
D
labetalol
E
magnesium sulfate
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy\1.Tonic-clonic seizures
Objective=n/a
Item Status=Dataloaded
Keywords=13480
Custom Item Label=13480
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
23/06/2017 07:58
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Dimensions
Groups=Acute management
Groups=Diagnosis
Groups=Interpretation
Groups=Pharmacology
Groups=Pregnancy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Neurological disorde
SCE Topics Neurology=HW1
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16386.2
43.
A 26-year-old woman presented with a history of three unilateral headaches over a
7-month period. Each episode was characterised by a severe right-sided headache that
lasted 12 hours, was preceded by teichopsia, and was associated with mild nausea.
What is the most appropriate initial treatment?
A
frovatriptan at the onset of the next attack
B
ibuprofen at the onset of the next attack
C
pizotifen prophylaxis
D
propranolol prophylaxis
E
sumatriptan at the onset of the next attack
Metadata
Domain=SCE Items
Topic=H.Neurology\8.Headache and facial pain\1.Migraine
Objective=n/a
Item Status=Dataloaded
Keywords=23360
Custom Item Label=23360
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16116.2
44.
A 37-year-old woman presented with a 4-month history of severe, recurrent, right-sided
retroorbital headache. She was having seven to ten attacks per day, each lasting 10–15
minutes. Between attacks, there was a dull, background pain. She noticed watering
from her eye during the attack and friends said that her face looked puffy, with drooping
of her right eyelid. Simple analgesics had not helped, but she was taking co-codamol
and propranolol.
What is the most appropriate treatment?
A
amitriptyline
B
indometacin
C
lamotrigine
D
lithium
E
verapamil
Metadata
Domain=SCE Items
Topic=H.Neurology\8.Headache and facial pain\6.Autonomic headache
Objective=n/a
Item Status=Dataloaded
Keywords=20294
Custom Item Label=20294
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Comment Text: Not to be used with 20295
[27/09/2012 16:47:23]
Extra Text:
Not to be used with 20295
[27/09/2012 16:47:06]
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Dimensions
Groups=Acute management
Groups=Chronic Management
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Pain and headache
SCE Topics Neurology=HB
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16117.2 - 20295
(Dataloaded)
23/06/2017 07:58
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Item I16368.3
45.
A 29-year-old man presented with agitation and drowsiness. Prior to admission he had
become apathetic and had gained 6 kg in weight.
On examination, he appeared unkempt. His GCS was 12, and his temperature was
38.0°C. His visual acuity was 6/18 bilaterally. There was horizontal nystagmus and
dysarthria.
Investigations:
plasma glucose
23.4 mmol/L
cerebrospinal fluid:
opening pressure
total protein
glucose
cell count
160 mmH2O (120–250)
0.55 g/L (0.15–0.45)
7.2 mmol/L (3.3–4.4)
14/µL (≤5); 100% lymphocytes
CT scan of head
right frontotemporal calcification
and oedema with leptomeningeal
contrast enhancement and dilated
ventricles
CT scan of thorax
mediastinal lymphadenopathy
What is the most useful diagnostic test?
A
brain biopsy
B
complement concentration
C
lymph node biopsy
D
MR scan of head
E
serum angiotensin-converting enzyme
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Metadata
Domain=SCE Items
Topic=H.Neurology\98.Neurology investigations
Objective=n/a
Item Status=Dataloaded
Keywords=23336
Custom Item Label=23336
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16404.2
46.
A 23-year-old man presented 1 hour after a head injury sustained while playing rugby.
He had briefly lost consciousness and was witnessed to have a few clonic movements
of the limbs. He regained consciousness within 30 seconds with no post-traumatic
amnesia or confusion.
On examination, his GCS was 15 and there were no abnormal neurological signs.
What is the most appropriate investigation?
A
EEG
B
MR brain scan
C
no investigation
D
serum prolactin
E
X-ray of skull
Metadata
Domain=SCE Items
Topic=H.Neurology\98.Neurology investigations
Objective=n/a
Item Status=Dataloaded
Keywords=23378
Custom Item Label=23378
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I15905.2
47.
A 72-year-old man presented with bilateral asymmetrical weakness of hand grip.
On examination, there was loss of muscle bulk on the volar aspect of the forearms and
impaired flexion of the distal interphalangeal joints of the fingers.
Impaired function of which muscle is chiefly contributing to the weakness seen?
A
flexor carpi radialis
B
flexor digitorum profundus
C
flexor digitorum superficialis
D
flexor pollicis brevis
E
flexor pollicis longus
Metadata
Domain=SCE Items
Topic=H.Neurology\99.Neurology symptoms/signs
Objective=n/a
Item Status=Dataloaded
Keywords=13385
Custom Item Label=13385
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Anatomy
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the per
SCE Topics Neurology=HS
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16364.2
48.
A 70-year-old woman developed features of Parkinson’s disease. Levodopa was
unhelpful. Nine months later her memory deteriorated. Cognitive function fluctuated and
she was worse at night, with confusion and visual hallucinations.
What is the most likely diagnosis?
A
corticobasal degeneration
B
dementia with Lewy bodies
C
multiple system atrophy
D
Parkinson’s disease with superimposed Alzheimer’s disease
E
vascular dementia
Metadata
Domain=SCE Items
Topic=H.Neurology\99.Neurology symptoms/signs
Objective=n/a
Item Status=Dataloaded
Keywords=23332
Custom Item Label=23332
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16388.2
49.
A 50-year-old man presented with daytime somnolence, anxiety and a feeling of
breathlessness especially when lying flat, which had increased over 6 weeks. There
was no history of lung disease. He was uncertain if he snored at night. He now sat up to
sleep.
Examination showed a BMI of 35 kg/m2 (18–25), collar size of 18 inches (46 cm) and no
spinal abnormality. Neurological and cardiac examinations were normal. He seemed
very anxious, panicky, tachypnoeic and was hyperventilating. He refused to lie down to
be examined, insisting that he would not be able to breathe.
Investigations:
ECG
normal
forced vital capacity:
sitting
semi-recumbent
3.0 L
1.2 L
What is the most likely cause of his symptoms?
A
hyperventilation due to anxiety disorder
B
laryngeal obstruction
C
obstructive sleep apnoea
D
severe expiratory muscle weakness
E
severe inspiratory weakness
Metadata
Domain=SCE Items
Topic=H.Neurology\99.Neurology symptoms/signs
Objective=n/a
Item Status=Dataloaded
Keywords=23362
Custom Item Label=23362
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
MRCPUK Proficiency Code=Code A
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16791.2
50.
A 70-year-old man presented acutely after a stroke.
Which clinical feature is most likely to suggest a dominant parietal lobe syndrome?
A
dressing dyspraxia
B
finger agnosia
C
sensory extinction
D
sensory neglect
E
topographical agnosia
Metadata
Domain=SCE Items
Topic=H.Neurology\99.Neurology symptoms/signs
Objective=n/a
Item Status=Dataloaded
Keywords=3267
Custom Item Label=3267
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HE
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I39914.1
51.
A 39-year-old man presented with a 3-week history of pain behind the right eye
radiating to the right forehead, followed by progressive diplopia and drooping of the right
upper eyelid.
On examination, there was partial right ptosis and partial ophthalmoplegia of the right
eye in all directions of movement. Both pupils responded to light. Visual acuity was 6/60
in the right eye and 6/6 in the left eye, and there was a right-sided relative afferent
pupillary defect. There was decreased cutaneous sensitivity over the right forehead, and
the right corneal reflex was absent.
Where is the most likely site of the lesion?
A
cavernous sinus
B
clivus
C
orbital apex
D
right dorsal midbrain
E
superior orbital fissure
Metadata
Domain=SCE Items
Topic=H.Neurology\99.Neurology symptoms/signs
Objective=n/a
Item Status=Create Item
Keywords=31133
Custom Item Label=31133
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Anatomy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17079.2
52.
A 45-year-old man presented with oscillopsia.
On examination, there was horizontal nystagmus in the primary position, the direction of
which reversed spontaneously every 90 seconds.
What is the most appropriate term for this type of nystagmus?
A
acquired pendular
B
ataxic
C
latent
D
periodic alternating
E
seesaw
Metadata
Domain=SCE Items
Topic=K.Ophthalmology\15.Nystagmus
Objective=n/a
Item Status=Dataloaded
Keywords=4500
Custom Item Label=4500
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Extra Text:
Not to be used with 4496, 4497, 4498, 4499, 4501
[27/09/2012 16:47:06]
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Dimensions
Groups=Anatomy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HP
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]:
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]:
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]:
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]:
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]:
23/06/2017 07:58
I17080.1 - 4501
I17076.1 - 4497
I17075.4 - 4496
I17077.1 - 4498
I17078.1 - 4499
(Dataloaded)
(Dataloaded)
(Dataloaded)
(Dataloaded)
(Dataloaded)
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Item I17463.2
53.
A 30-year-old woman presented with an eye movement abnormality.
On examination, attempted horizontal pursuit movements were characterised by failure
of abduction, in the presence of pupillary constriction.
What is the most likely diagnosis?
A
convergence spasm
B
Duane syndrome
C
Miller Fisher syndrome
D
myasthenia gravis
E
Parinaud’s syndrome
Metadata
Domain=SCE Items
Topic=K.Ophthalmology\99.Ophthalmology symptoms/signs
Objective=n/a
Item Status=Dataloaded
Keywords=8454
Custom Item Label=8454
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16093.2
54.
A 19-year-old man presented with clumsiness, speech and behaviour disturbance of
10 years' duration. There had been learning difficulties at school.
On examination, he had a large head and ears, a long face, high-arched palate, a
prominent jaw, large testes and mild ataxia.
What is the most likely diagnosis?
A
fragile X syndrome
B
homocystinuria
C
Marfan syndrome
D
Rett syndrome
E
spinal dysraphism with hydrocephalus
Metadata
Domain=SCE Items
Topic=L.Psychiatry\10.Learning disability
Objective=n/a
Item Status=Dataloaded
Keywords=17208
Custom Item Label=17208
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HX3
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I17150.2
55.
A 23-year-old woman with severe learning difficulties was referred because of refractory
epilepsy. Her first seizure had occurred 2 days after she was immunised at the age of
4 months. By the age of 6 months, seizures were occurring daily. Her current seizures
comprised atypical absences, focal dyscognitive seizures, myoclonus and occasional
convulsive status epilepticus. She had used a wheelchair since the age of 14.
On examination, she became agitated. There was moderate spasticity and weakness in
all four limbs. Her reflexes were brisk throughout.
In which gene is there most likely to be an abnormality?
A
CACNA1H
B
CHRNA4
C
EPM1
D
EPM2a
E
SCN1A
Metadata
Domain=SCE Items
Topic=L.Psychiatry\10.Learning disability
Objective=n/a
Item Status=Dataloaded
Keywords=4571
Custom Item Label=4571
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
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Dimensions
Groups=Associated Features
Groups=Diagnosis
Groups=Genetics/Congenital
Groups=Investigations
Groups=Paediatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HW5
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16503.2
56.
A 24-year-old soldier was involved in an ambush during which the car he was travelling
in was blown up by a land mine. He sustained minor limb and facial injuries, but the
other two occupants of the car were killed. Two weeks after the incident, he complained
of intermittent headaches, nightmares, poor concentration and anxiety. He expressed
guilt at being the only person to survive the explosion and expressed a wish to leave the
Army.
On examination, he was distressed and tearful.
What is the most likely diagnosis?
A
acute depressive episode
B
adjustment disorder
C
factitious disorder
D
panic disorder
E
post-traumatic stress disorder
Metadata
Domain=SCE Items
Topic=L.Psychiatry\6.Stress and adjustment disorder\3.Adjustment disorder
Objective=n/a
Item Status=Dataloaded
Keywords=27555
Custom Item Label=27555
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HX8
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16258.2
57.
A 17-year-old Chinese boy developed complex partial seizures. Before starting
antiepileptic treatment he was found to have the HLA-B*1502 allele.
What medication would be most suitable?
A
carbamazepine
B
lamotrigine
C
levetiracetam
D
oxcarbazepine
E
phenytoin
Metadata
Domain=SCE Items
Topic=Q.Therapeutics and Toxicology\18.Adverse drug reactions
Objective=n/a
Item Status=Dataloaded
Keywords=20563
Custom Item Label=20563
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Adolescent medicine
Groups=Chronic Management
Groups=Pharmacology
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HF
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I15919.2
58.
A 47-year-old man with poorly controlled epilepsy was taking lamotrigine 500 mg daily.
Sodium valproate was added at 600 mg daily and the lamotrigine dosage was reduced
to 400 mg daily.
One week later, he became dizzy and unsteady.
What is the most likely explanation?
A
inhibition of lamotrigine metabolism by sodium valproate
B
inhibition of sodium valproate metabolism by lamotrigine
C
neurotoxicity of sodium valproate
D
non-convulsive status epilepticus
E
vestibular neuritis
Metadata
Domain=SCE Items
Topic=Q.Therapeutics and Toxicology\19.Drug interactions
Objective=n/a
Item Status=Dataloaded
Keywords=13399
Custom Item Label=13399
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Pharmacology
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HF
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
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Item I16255.2
59.
A 32-year-old woman was assessed in the emergency department after a seizure. She
had remained drowsy and could not provide any history. Her family knew that she took
medicines for psychosis and depression, but they were uncertain what she was
currently taking. They had brought a bag containing medication that she had taken over
the years. The bag contained amitriptyline, clozapine, haloperidol, lithium carbonate and
venlafaxine.
What drug, taken at standard dosage, is most likely to have provoked her seizures?
A
amitriptyline
B
clozapine
C
haloperidol
D
lithium
E
venlafaxine
Metadata
Domain=SCE Items
Topic=Q.Therapeutics and Toxicology\4.Neurological/psychiatric\2.Anti-psychotics
Objective=n/a
Item Status=Dataloaded
Keywords=20559
Custom Item Label=20559
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Pharmacology
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HO
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16829.2
60.
A 25-year-old man with juvenile myoclonic epilepsy failed to tolerate treatment with
sodium valproate because of weight gain and sedation.
What is the most appropriate alternative treatment?
A
clobazam
B
levetiracetam
C
oxcarbazepine
D
pregabalin
E
tiagabine
Metadata
Domain=SCE Items
Topic=Q.Therapeutics and Toxicology\4.Neurological/psychiatric\8.Anti-epileptics
Objective=n/a
Item Status=Dataloaded
Keywords=3377
Custom Item Label=3377
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Chronic Management
Groups=Pharmacology
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HF
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I16508
61.
A 67-year-old man presented following a stroke that had caused a mild left hemiparesis.
He drank at least 60 units of alcohol per week. Two days after admission, he became
agitated and tearful, stating that the medical and nursing staff were trying to kill him.
On examination, he was agitated, disorientated in time and place, and tremulous.
In addition to thiamine, what is the most appropriate immediate treatment?
A
acamprosate
B
clomethiazole
C
disulfiram
D
haloperidol
E
lorazepam
Metadata
Domain=SCE Items
Topic=L.Psychiatry\1.Organic mental disorder\3.Delirium
Objective=n/a
Item Status=Dataloaded
Keywords=27560
Custom Item Label=27560
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Acute management
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HX8
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I55751.3
62.
A 5-year-old girl presented with a history of treatment-refractory generalised tonic
seizures from the age of 2. During some of these seizures, she would drop to the
ground and sustain injury. She was born at term and had psychomotor delay with
behavioural abnormalities predating the seizure onset. She was taking a combination of
sodium valproate, levetiracetam and lamotrigine.
On examination, she was cognitively impaired. During examination, she suddenly
screamed and developed a tonic seizure.
Investigations:
ictal EEG
2-Hz spike-and-wave discharge
What would be the most appropriate additional therapy to control her seizures?
A
carbamazepine
B
gabapentin
C
perampanel
D
rufinamide
E
topiramate
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy
Objective=n/a
Item Status=Create Item
Keywords=661445
Custom Item Label=661445
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Chronic Management
Groups=Diagnosis
Groups=Interpretation
Groups=Paediatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Neurological disorde
SCE Topics Neurology=HX6
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55750.1 - 661444 (Create
Item)
23/06/2017 07:58
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Item I16294.1
63.
A 43-year-old man presented with a 2-day history of neck pain and a 2-hour history of a
severe swallowing problem. He had undergone surgery for a bicuspid aortic valve in the
past. He was taking atenolol for hypertension.
On examination, there was left-sided ptosis and miosis but normal eye movements. He
had a hoarse voice and a bovine cough, with deviation of the left pharyngeal wall to the
right on attempted phonation. The tongue deviated to the left on protrusion. Facial and
intraoral sensation was normal. There were no signs in the limbs.
Investigations:
CT scan of head
normal
What is the most likely diagnosis?
A
left carotid artery dissection
B
left lateral medullary infarction
C
left paramedian thalamic infarction
D
left vertebral artery dissection
E
right medullary infarction
Metadata
Domain=SCE Items
Topic=H.Neurology\1.Cerebrovascular disease
Objective=n/a
Item Status=Dataloaded
Keywords=20704
Custom Item Label=20704
Current Activity=n/a
Item Editor=External Import
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Anatomy
Groups=Diagnosis
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cerebrovascular dise
SCE Topics Neurology=HG
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I55772.1
64.
A 5-year-old boy was brought to the paediatric neurologist by his parents because of his
mirror writing. He was left-handed, and had been born at full-term with minor delays in
language development.
His neurological examination was normal.
What is the most appropriate next management step?
A
cognitive behavioural therapy
B
encourage him to write with his right hand
C
reassure that no action is currently needed
D
referral to learning disability services
E
speech and language therapy
Metadata
Domain=SCE Items
Topic=H.Neurology\21.Congenital/developmental disorders
Objective=n/a
Item Status=Create Item
Keywords=661447
Custom Item Label=661447
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Paediatric
Groups=Prognosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HW5
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I55450
65.
A 19-year-old man presented with refractory epilepsy. He had frequent clonic,
myoclonic and absence seizures. He had moderate behavioural and learning disabilities
following a prolonged febrile seizure at 1 year of age.
He had had several episodes of status epilepticus over his lifetime, and clusters of
seizures with infections or vaccinations.
What investigation is most likely to be diagnostic?
A
EEG
B
gene testing
C
karyotyping
D
MR scan of brain
E
muscle biopsy
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy
Objective=n/a
Item Status=Create Item
Keywords=661230
Custom Item Label=661230
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Not with 661229 [15/04/2016 16:12:28]
23/06/2017 07:58
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Dimensions
Groups=Adolescent medicine
Groups=Associated Features
Groups=Diagnosis
Groups=Genetics/Congenital
Groups=Paediatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Cognitive
SCE Topics Neurology=HW5
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55448 - 661229 (Create Item)
23/06/2017 07:58
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Item I16918.2
66.
A 49-year-old man attended the outpatient clinic with his wife, who described his sleep
disturbance over the previous 3 years. He would shout out, swear, kick and punch,
waking his wife and sometimes hitting her. This occurred at least monthly and, rarely,
twice in the same night. He appeared to be asleep during the episodes and, if woken,
recalled a violent dream in which enemy soldiers were attacking him. His medical
history and family history were unremarkable.
Examination was normal.
What additional neurological condition is he most likely to develop?
A
Alzheimer’s disease
B
Creutzfeldt–Jakob disease
C
frontotemporal dementia
D
narcolepsy
E
Parkinson’s disease
Metadata
Domain=SCE Items
Topic=H.Neurology\17.Sleep disorders
Objective=n/a
Item Status=Dataloaded
Keywords=3521
Custom Item Label=3521
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Not to be used with 3522 or 3529
[27/09/2012 16:47:23]
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Dimensions
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HD
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16919.2 - 3522 (Dataloaded)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I16925.4 - 3529 (Dataloaded)
23/06/2017 07:58
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Item I17172
67.
A 24-year-old man presented following a single generalised tonic-clonic seizure. He had
a history of blank spells between the ages of 8 and 11 years, and recent limb jerking.
Investigations:
EEG
see image
What is the most appropriate treatment?
A
carbamazepine
B
ethosuximide
C
lamotrigine
D
levetiracetam
E
sodium valproate
Metadata
Domain=SCE Items
Topic=H.Neurology\7.Loss of consciousness\2.Epilepsy\1.Tonic-clonic seizures
Objective=n/a
Item Status=Dataloaded
Keywords=4601
Custom Item Label=4601
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Chronic Management
Groups=Diagnosis
Groups=Interpretation
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Disorders of conscio
SCE Topics Neurology=HF
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I55850.1
68.
A 37-year-old woman presented with left-sided facial weakness and loss of taste
sensation on the left side of her tongue anteriorly.
What is the central destination of taste fibres from the anterior two-thirds of the tongue?
A
facial nucleus
B
nucleus ambiguus
C
nucleus of tractus solitarius
D
red nucleus
E
superior olivary nucleus
Metadata
Domain=SCE Items
Topic=H.Neurology\16.Neuropathy\2.Cranial neuropathies
Objective=n/a
Item Status=Create Item
Keywords=661271
Custom Item Label=661271
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Anatomy
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the cra
SCE Topics Neurology=HQ
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I17264.2
69.
A 45-year-old man presented with mild dysarthria and dysphagia, and muscle cramps
that disturbed him if he walked too far or too fast. There was no family history of note.
On examination, he had slight dysarthria and fasciculations around his mouth. He had a
waddling gait and mild proximal limb weakness with preserved reflexes.
What additional sign is most likely to be present?
A
cataracts
B
gynaecomastia
C
myotonia
D
testicular atrophy
E
thyroid enlargement
Metadata
Domain=SCE Items
Topic=H.Neurology\14.Motor neurone disease
Objective=n/a
Item Status=Dataloaded
Keywords=8002
Custom Item Label=8002
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
Dimensions
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Disorders of the spi
SCE Topics Neurology=HN
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I55945.1
70.
A 27-year-old man sustained a serious head injury in a road traffic collision. Two weeks
later, he was still unrousable, failing to respond to any stimulus, with no sleep–wake
cycle or any voluntary actions.
What is the most accurate description of this disorder?
A
brainstem death
B
coma
C
locked-in syndrome
D
minimally conscious state
E
vegetative state
Metadata
Domain=SCE Items
Topic=H.Neurology\2.Coma and brain death
Objective=n/a
Item Status=Create Item
Keywords=661282
Custom Item Label=661282
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Do not use with 661283, 661284, 661285 and 661286
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Management
SCE Topics Neurology=HX4
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55946.3 - 661283 (Create
Item)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55951.2 - 661286 (Create
Item)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55947.1 - 661284 (Create
Item)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I55949.1 - 661285 (Create
Item)
23/06/2017 07:58
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Item I17094
71.
A 34-year-old woman gave a 6-month history of urinary frequency and urgency with
constipation.
On examination, knee and ankle reflexes were brisk; plantar responses were flexor.
Investigations:
urodynamic studies
see image
What is the most appropriate interpretation of the trace?
A
cough impulses
B
detrusor overactivity
C
external abdominal pressure (Credé’s manoeuvre)
D
intermittent outflow obstruction
E
vesicoureteric reflux
Metadata
Domain=SCE Items
Topic=H.Neurology\98.Neurology investigations
Objective=n/a
Item Status=Dataloaded
Keywords=4515
Custom Item Label=4515
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
2017 QWG: We felt this was ok unchanged – perhaps just label X-axis with ‘time’ [25/04/2017
13:06:04]
EB 2016 comments: send to QWG. Please research a better image; axis labels? What is the right
terminology for the study? [15/09/2016 09:57:23]
Not to be used with 4511, 4512, 4513, 4514 [15/09/2016 09:56:56]
23/06/2017 07:58
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Dimensions
Groups=Interpretation
Groups=Investigations
Groups=Physiology
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HX13
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I17093 - 4514 (Dataloaded)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I17092.4 - 4513 (Dataloaded)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I17090.2 - 4511 (Dataloaded)
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I17091.1 - 4512 (Dataloaded)
23/06/2017 07:58
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Item I59983.1
72.
A 39-year-old woman presented with a 7-year history of fluctuating hearing impairment,
tinnitus, fullness in the ears, and paroxysmal attacks of vertigo with loss of balance
lasting up to 2 hours. She worked as an underground train driver. Her daughter also
experienced intermittent dizziness and had been found to have anxiety disorder.
On examination, head impulse test was normal.
Investigations:
MR scan of brain and internal auditory meatus
normal
What is the most likely diagnosis?
A
benign paroxysmal positional vertigo
B
endolymphatic fistula
C
episodic ataxia type 2
D
industrial hearing loss
E
Ménière’s disease
Metadata
Domain=SCE Items
Topic=H.Neurology\6.Dizziness\3.Meniere's disease
Objective=n/a
Item Status=Create Item
Keywords=771830
Custom Item Label=771830
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Dimensions
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neurogenetics, neuro
SCE Topics Neurology=HX5
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I51613.2
73.
A 24-year-old woman presented with a 2-month history of morning headaches.
On examination, she had moderate bilateral papilloedema.
What is the most characteristic visual symptom associated with this sign?
A
blackening of whole of vision on standing
B
flashing white dots when eyes are closed
C
general blurring of vision
D
greying of central vision on bending
E
tunnel vision with coughing
Metadata
Domain=SCE Items
Topic=H.Neurology\20.Benign intracranial hypertension
Objective=n/a
Item Status=Create Item
Keywords=551828
Custom Item Label=551828
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
Not with 551829 [12/05/2015 12:27:16]
Dimensions
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Neuro-inflammatory d
SCE Topics Neurology=HJ
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
Item Exclusions - Validation [Enemy - Validate Only (symmetric)]: I51614.1 - 551829 (Create
Item)
23/06/2017 07:58
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Item I16629.2
74.
A 44-year-old man reported a 3-month history of generalised headache. The headache
had worsened over the previous 10 days, particularly on waking. It was present most of
the time but was much worse on standing or moving.
On examination, there were generally brisk deep tendon reflexes.
Investigations:
MR scan of brain (coronal T1 with gadolinium)
see image
What is the best explanation for the imaging findings?
A
idiopathic intracranial hypertension
B
inflammatory pachymeningitis
C
intracranial hypotension
D
malignant leptomeningitis
E
venous sinus thrombosis
Metadata
Domain=SCE Items
Topic=H.Neurology\8.Headache and facial pain
Objective=n/a
Item Status=Dataloaded
Keywords=27732
Custom Item Label=27732
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Dimensions
Groups=Diagnosis
Groups=Interpretation
MRCPUK Proficiency Code=Code B
SCE Blueprints Neurology=Pain and headache
SCE Topics Neurology=HB
Specialty Code=NEUROLOGY
Type Code=SCE WEB
Relations
n/a
23/06/2017 07:58
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Item I15914.1
75.
A 78-year-old man described painful sensations associated with an urge to move his
right leg, worse in bed at night and disturbing his sleep. He had some relief from
stretching his leg or getting out of bed and walking about.
On examination, he had absent ankle jerks and a mildly slowed gait. Vibration sense
was retained at his ankles.
Investigations:
serum ferritin
estimated glomerular filtration rate
8 µg/L (15–300)
50 mL/min/1.73 m2 (>60)
What is the most appropriate drug treatment?
A
amitriptyline
B
ferrous sulfate
C
pramipexole
D
quinine
E
temazepam
Metadata
Domain=SCE Items
Topic=H.Neurology\5.Movement disorders
Objective=n/a
Item Status=Dataloaded
Keywords=13394
Custom Item Label=13394
Current Activity=n/a
Item Editor=External Import
Template=Multiple Choice
Comments
JM: I have altered option B from ‘oral iron’ to ‘ferrous sulphate’. Specifying the route tended to
draw attention to it.
[27/09/2012 16:47:23]
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Dimensions
Groups=Chronic Management
Groups=Diagnosis
Groups=Geriatric
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code C
SCE Blueprints Neurology=Parkinsonism and mov
SCE Topics Neurology=HM
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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Item I39944.1
76.
A 16-year-old boy presented with daily episodes of dizziness, unsteadiness and slurred
speech lasting for approximately 2 minutes. The episodes had been occurring since he
was 2 years old and were brought on by activities such as running, horse riding and
trampolining.
Neurological examination was normal.
Investigations:
MR scan of brain
normal
What type of episodic ataxia is the most likely diagnosis?
A
1
B
2
C
3
D
5
E
6
Metadata
Domain=SCE Items
Topic=H.Neurology\6.Dizziness\5.Cerebellar ataxia
Objective=n/a
Item Status=Create Item
Keywords=31228
Custom Item Label=31228
Current Activity=n/a
Item Editor=Legacy Item Editor (J#)
Template=Multiple Choice
Comments
n/a
23/06/2017 07:58
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Pool - SCE Neurology Web Questions
Dimensions
Groups=Adolescent medicine
Groups=Diagnosis
Groups=Symptoms and signs
MRCPUK Proficiency Code=Code A
SCE Blueprints Neurology=Parkinsonism and mov
SCE Topics Neurology=HM
Specialty Code=NEUROLOGY
Type Code=SCE BOF
Relations
n/a
23/06/2017 07:58
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