Source

Organized by
Headache
TTT:
NSAIDs if not effective =D Trip Tans

TTT look
:
oxygare

TTT :
Paracetamol
 > So ESR Steroid
old
age ,
> too ,
Next step →
High Jose

9 with Bensing forward .

Grated of the Steroid

TTT:
stopping tray . .

may be used in severe cases .

Anti -

epliptic
 manse
vomiting
+
Ms 8
'

if I# ?
↳

TCA SSRIs Josif Beta blockers

contraindicated
are

↓
Anti epliptic
first _
line prophylaxis
in tension headache
 :
-

-
Clinical diagnosis, at least 2 of the following to diagnose:- bradykinesia,
cogwheel rigidity, resting tremor (asymmetric at onset), postural reflex
abnormality (falling)

Important to memorize medication induced parkinsonism (symmetrical at

onset):- Metoclopramide, Haloperidol and Methyldopa
N.B: Early dementia within the first year of the appearance of parkinsonism is a
hall mark of dementia with lewy body!
Treatment:- Levodopa with Carbidopa

Frontal sinus headache, how to reach the

diagnosis?
A- Full history and examination 1ˢᵗ any type of in headache

B- CT Paranasal sinus
C- CT brain
D- MRI brain
The answer is A

Patient with headache that comes and goes a

lot during the last months and it is usually on
the left or right sinus, she used over the
counter analgesic and decongestants but didn't
help, she complains now of severe headache,
she's otherwise healthy with no symptoms,
what will you order to confirm the diagnosis?
A- ESR
B- CT of paranasal sinuses =p sinusitis
C- MRI brain
D- MRI spine
The answer is B
Headache that is throbbing and unilateral
aggravating with light and movement, what is
the diagnosis? Unilateral throbbing aura
, ,

A- Migraines →

B- Cluster headache Pain →

eye www.M § &#
over 1 . .

.
- -

got if

C- Subarachnoid hemorrhage Sutter worst headache my →

, in life

D- Tension headache high if suspicions but CT is normal → Do lumber pentane To see the blood

↳ Bilateral
,
mostly occupit ,
Bart -

like
, PE center stress .

The answer is A

Describe migraine headache?

A- Recurrent headache of < 4 hours > 4h

B- Unilateral throbbing headache I

C- Aura following the headache proceed

D- Bilateral band-like headache Tension headache →

The answer is B
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

Patient developed sudden onset headache

when he was bending to take his keys from the
ground, described it as worst headache in his
life, what is the most likely diagnosis?
A- Subarachnoid Hemorrhage
B- Cluster headache
C- Cervical spondylosis
D- Migraine

The answer is A
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

Patient presented with worst headache in his

live, negative CT brain, what is the next
investigations?
A- Lumbar puncture
B- MRI brain
C- EEG
D- Echocardiography

The answer is A
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

Headache in child, band like, throbbing pain,

with stress at school, what is the diagnosis?
A- Tension headache
B- Migraine
C- Subarachnoid hemorrhage
D- Cluster headache

The answer is A
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

Patient with unilateral headache on temple

area, laboratory results showed ESR: 112, what
is the most likely diagnosis? > too

A- Tension headache
B- Temporal arteritis next
high tote sterile→
-

C- Subarachnoid hemorrhage
D- Cluster headache

The answer is B
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

45-year-old male diabetic patient presented

with dull aching headache increase with
straining and coughing, upon examination
there is tenderness allover the eyebrows, what
is the most likely diagnosis?
A- Viral meningitis
B- TB meningitis
C- Brain abscess
D- Sinusitis

The answer is D
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

Patient with headache same as tension

headache band like with stress, pain is lasted
for one month and he is using paracetamol day
after day. What is the type of headache?
A- Over use drug headache
B- Subarachnoid hemorrhage
C- Acute sinusitis
D- Cervical spondylosis

The answer is A
Initial step to diagnose headache is to take full history and examination:
Migraine:- Unilateral pulsatile or throbbing pain, preceded by flashing light or
zigzag lines (aura), photophobia
Cluster headache:- Pain over one eye, lasting for minutes to hours, associated
with lacrimation, rhinorrhea and flushing of the forehead, lasts several weeks a
few times a year
Tension headache:- Episodic or chronic, bilateral over the occiput, frontal or
temporal, band-like or tightness in nature
Infection (meningitis, encephalitis or brain abscess): Generalized headache
associated with photophobia with a stiff neck is typically for meningitis
Intracerebral bleeding (subdural hematoma, subarachnoid or intracerebral
haemorrhage):- Sudden severe onset, initially localized but becomes
generalized, associated with neck stiffness
Temporal arteritis:- Persistent unilateral over the temporal area, associated with
blurred vision, diplopia, jaw claudication or jaw pain during eating which can lead
to loss of weight
Acute sinusitis:- Associated with pain or fullness behind the eyes or over the
cheeks or forehead
Cervical spondylosis:-Pain over the occiput, associated with neck stiffness
Raised intracranial pressure (brain tumor or idiopathic intracranial HTN):-
Generalized, worse in morning and with coughing, associated with drowsiness
and vomiting, history of using OPs in obese woman (idiopathic intracranial
hypertension)
Medication overuse headache:- History of using of analgesia especially codeine
and opiate for 10-15 days per month

Trigeminal neuralgia:- Brief paroxysms of unilateral lancinating pain in the V2 or

V3 distribution of the trigeminal nerve, triggeredby light touch of the affected
area, Carbamazepine is the treatment

A young female presents with unilateral

throbbing headache, her headache is
associated with nausea and vomiting. She tells
you that she is sensitive to
light. Which of the following is used for acute
treatment?
A- Aspirin for mild
→ instable
5

B-Triptan for severe

→ a Nawsa 8
Vomiting I'

C- Beta blocker Prophylaxis

→

D- 100% oxygen for Chester headache

→
.

The answer is B
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month
Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),
Amitriptyline, Topiramate, Valproic acid and Venlafaxine

25-year-old pregnant lady known case of

migraine, during pregnancy it improved. tried
to reduce work stress. What is the best
accomplishment of preventing migraine attack?
contraindicated
A- Biofeedback →
if Beta Blocker is

B- Beta blocker → No contraindications

C- Sumatriptan → for acne treatment

D- 100% oxygen → for

chooser heartache

The answer is B
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month

Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),

Amitriptyline, Topiramate, Valproic acid and Venlafaxine
35-year-old female presented with unilateral
peri-orbital headache, associated with
lacrimation and rhinorrhea, she claimed that
this headache occurs every year at the same
time, what is the acute management?
A- Sumatriptan
B- 100% oxygen
C- NSAIDs
D- Beta blocker

The answer is B
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month

Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),

Amitriptyline, Topiramate, Valproic acid and Venlafaxine
35-year-old female presented with unilateral
peri-orbital headache, associated with
lacrimation and rhinorrhea, she claimed that
this headache occurs every year at the same
time, what do we use as a prophylactic
medication?
A- Sumatriptan Migraine→
Awa -
-

B- 100% oxygen Aaa attack

→

C- Verapamil ≤CB →
cluster

D- Beta blocker
-

Migraine
→

Prophylaxis
-
_

The answer is C
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month

Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),

Amitriptyline, Topiramate, Valproic acid and Venlafaxine
Best treatment of trigeminal neuralgia?
A- Sumatriptan
B- Carbamazepine
C- Prednisolone
D- Naloxone

The answer is B
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month

Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),

Amitriptyline, Topiramate, Valproic acid and Venlafaxine
Female came complaining of headache and
sudden painful loss of vision, Examination: loss
of vision in right eye. CT brain: pituitary
hemorrhage, MRI brain: pituitary massive
hemorrhage and compressing on optic chiasma
and cavernous sinus. Best next step?
A- Close observation
B- Medical therapy
C- Inferior petrosal sinus sampling
D- Urgent neurosurgery referral

The answer is D
POUND mnemonic to diagnose Migraine
Pulsatile quality
One day duration ( between 4 and 72 hours)
Unilateral in location
Nausea or vomiting
Disabling intensity (patient goes to bed)
Management of migraine:
Acute mild to moderate > Aspirin or NSAIDs
Acute moderate to severe or poor response to NSAIDs > Triptan
Migraine associated with vomiting >> nasal or SC Triptan
N.B: Triptan are contraindication in CAD, cerebrovascular disease, brainstem
aura and hemiplegic migraine
Choose migraine prophylaxis when
Migraine do not respond to therapy
Headache occur >= 10 days per month
Using acute migraine medication is >= 8 days per month
Disabling headache >= 4 days per month

Migraine prophylaxis:- Beta blocker (Metoprolol, Propranolol, Timolol),

Amitriptyline, Topiramate, Valproic acid and Venlafaxine
Stroke
:-& D. % s
65-year-old presenter to ER with sudden right
side weakness 4 hours ago, what is the most
important next step?
A- Thrombolytic
B- Chest X-ray
C-ECG
D- CT brain
The answer is D
What do you need to know about stroke management?
CT BRAIN is mandatory and it IS the most important step in any patient
presented with neurological deficit
It will differentiate between Ischemic stroke vs Hemorrhagic stroke

Management:
Hemorrhagic stroke > Neurosurgery referral
Ischemic stroke >> within window period (4.5 hours) or no?
Out of the window >> Dual antiplatelet (Aspirin and Clopidogrel)
Within window >> thrombolytic if no contraindication and hold Antiplatelet in 1st
24 hours

N.B: Remember to differentiate acute stroke from transient ischemic attack (TIA)
TIA is defined by the absence of infarction on neuroimaging, independent of
symptoms duration, which typically lasts from 5 to 60 minutes
N.B: Rule out atrial fibrillation as the most common cause of cryptogenic stroke
63-year-old presented to ER with sudden left
side weakness 6 hours ago associated with
dysarthria, CT brain done showed acute
ischemic insult, BP is 160/95, what is the most
appropriate management?
A- Thrombolytic out of wonsow
→

B- Aspirin ✓

C- Control his blood pressure Do not give anti Hypertensive unless -

BP >

P
2201lb
the blood

D- Close observation protective

9 BP is
body
a
mechanism Foon the To

that reaches The brain

The answer is B
.

What do you need to know about stroke management?

CT BRAIN is mandatory and it IS the most important step in any patient
presented with neurological deficit
It will differentiate between Ischemic stroke vs Hemorrhagic stroke

Management:
Hemorrhagic stroke > Neurosurgery referral
Ischemic stroke >> within window period (4.5 hours) or no?
Out of the window >> Dual antiplatelet (Aspirin and Clopidogrel)
Within window >> thrombolytic if no contraindication and hold Antiplatelet in 1st
24 hours

N.B: Remember to differentiate acute stroke from transient ischemic attack (TIA)
TIA is defined by the absence of infarction on neuroimaging, independent of
symptoms duration, which typically lasts from 5 to 60 minutes
N.B: Rule out atrial fibrillation as the most common cause of cryptogenic stroke

Patient with transient visual loss lasted less

than 60 minutes and resolved without any
intervention, normal CT brain, what is the most
likely diagnosis?
A- Transient ischemic attack
B- Acute stroke
C- Multiple sclerosis
D- Myasthenia gravis
The answer is A
What do you need to know about stroke management?
CT BRAIN is mandatory and it IS the most important step in any patient
presented with neurological deficit
It will differentiate between Ischemic stroke vs Hemorrhagic stroke
Management:
Hemorrhagic stroke > Neurosurgery referral
Ischemic stroke >> within window period (4.5 hours) or no?
Out of the window >> Dual antiplatelet (Aspirin and Clopidogrel)
Within window >> thrombolytic if no contraindication and hold Antiplatelet in 1st
24 hours

N.B: Remember to differentiate acute stroke from transient ischemic attack (TIA)
TIA is defined by the absence of infarction on neuroimaging, independent of
symptoms duration, which typically lasts from 5 to 60 minutes
N.B: Rule out atrial fibrillation as the most common cause of cryptogenic stroke

Best way to prevent stroke?

A- Diabetes control
B- Prophylactic aspirin
C- Blood pressure control
D- No way of prevention
The answer is C
What do you need to know about stroke management?
CT BRAIN is mandatory and it IS the most important step in any patient
presented with neurological deficit
It will differentiate between Ischemic stroke vs Hemorrhagic stroke

Management:
Hemorrhagic stroke > Neurosurgery referral
Ischemic stroke >> within window period (4.5 hours) or no?
Out of the window >> Dual antiplatelet (Aspirin and Clopidogrel)
Within window >> thrombolytic if no contraindication and hold Antiplatelet in 1st
24 hours

N.B: Remember to differentiate acute stroke from transient ischemic attack (TIA)
TIA is defined by the absence of infarction on neuroimaging, independent of
symptoms duration, which typically lasts from 5 to 60 minutes
N.B: Rule out atrial fibrillation as the most common cause of cryptogenic stroke
Case of stroke with MAP = 65 and intra-cranial
pressure = 15, calculate the cerebral perfusion
pressure? ICP MAP -
=

A- 40
B- 50
C- 60
D- 70
The answer is B
What do you need to know about stroke management?
CT BRAIN is mandatory and it IS the most important step in any patient
presented with neurological deficit
It will differentiate between Ischemic stroke vs Hemorrhagic stroke

Management:
Hemorrhagic stroke > Neurosurgery referral
Ischemic stroke >> within window period (4.5 hours) or no?
Out of the window >> Dual antiplatelet (Aspirin and Clopidogrel)
Within window >> thrombolytic if no contraindication and hold Antiplatelet in 1st
24 hours

N.B: Remember to differentiate acute stroke from transient ischemic attack (TIA)
TIA is defined by the absence of infarction on neuroimaging, independent of
symptoms duration, which typically lasts from 5 to 60 minutes
N.B: Rule out atrial fibrillation as the most common cause of cryptogenic stroke
GBS
 Mysterion gravies GBS

88-year-old male known case ofreflexHTN presented

reflex• Intact • A
in

with unsteady gait, later he developed

the
Sending
• Worsen at

the
end of • A-

day
forgetfulness, what is the most likely
diagnosis?
A- Alzheimer disease
B- Frontotemporal dementia
C- Normal tension hydrocephalus
D- Cruetzfelt jakob disease
The answer is C
K Both are good is

24-year-old male medically free had URTI 2

weeks ago and now developed back pain,
ascending lower limbs bilateral flaccid paralysis
spreads from the lower to the upper limbs in a
"stocking-glove" distribution and absent
reflexes, what is the most likely diagnosis?
A- Myasthenia gravis
B- Guillain-Barré syndrome
C- Brain tumor
D- Giant cell arteritis it heartache
◦

The answer is B age /

Guillain Barre syndrome:

Acute ascending areflexic paralysis and paresthesia (distal to proximal) with
history of URTI or GLinfection (Campylobacter jeujeni) multiple weeks ago
Diagnosis:
Clinically, CSF sample may showed high protein and normal cell count
Treatment:
IVIG or plasma exchange
Prognosis is excellent with full recovery in most of the patient

35-year-old male with history of recent diarrhea

came with lower limb weakness (ascending in
nature), what is the best treatment for him?
A- Intravenous immunoglobulin
B- IV Methylprednisolone in MS →

C- Antibiotic diarrhea resolved

→

D- Supportive treatment
The answer is A
Guillain Barre syndrome:
Acute ascending areflexic paralysis and paresthesia (distal to proximal) with
history of URTI or GLinfection (Campylobacter jeujeni) multiple weeks ago
Diagnosis:
Clinically, CSF sample may showed high protein and normal cell count
Treatment:
IVIG or plasma exchange
Prognosis is excellent with full recovery in most of the patient

Patient with ascending limb weakness with

history of gastroenteritis 3 weeks back, what is
the mostly prognosis of these diseases?
A- Deterioration
B- Resolve with weakness
C- Full recovery
D- Resolve with dysarthria
The answer is C
Guillain Barre syndrome:
Acute ascending areflexic paralysis and paresthesia (distal to proximal) with
history of URTI or GLinfection (Campylobacter jeujeni) multiple weeks ago
Diagnosis:
Clinically, CSF sample may showed high protein and normal cell count
Treatment:
IVIG or plasma exchange
Prognosis is excellent with full recovery in most of the patient
Myasthenia

gravis
µ fating ability at the end at the day

24-year-old patient presentif with tobilateral

+ve
ptosis, proximal
tymomac-omy.is may improved
✗ .

µ
lower and upper
limbs weakness, Simpson test was positive and after
doing edrophonium test
there was rapid improvement of the ptosis, what is the
most appropriate
management?
A- Pyridostigmine
B- Rivastigmine
C- Physostigmine
D- IV Corticosteroid

Pediatric patient with ptosis, diplopia with no fasciculation, symptoms worse

through the day and improve next morning, what is the pathophysiology of the
disease?

A- Anti-bodies against thyroid peroxidase

B- Anti-bodies against Acetyl choline receptors
C- Anti-bodies against double-strand DNA
D- Anti-nuclear antibodies
7
24-year-old patient present with bilateral ptosis, proximal lower and upper
*I

limbs weakness, Simpson test was positive and after doing edrophonium test
2K

there was rapid improvement of the ptosis, what is the most appropriate
management? * Test for ocular muscles Prone
a
Mds

for
2←
Diagnostic Ma

A- Pyridostigmine
B- Rivastigmine
C- Physostigmine
D- IV Corticosteroid

Patient known case of myasthenia gravis came to ER with myasthenic crisis,

he is on pyridostigmine, what to do for him in ER?

A- Plasmapheresis
B- IV Corticosteroids
C- Antibiotics
D- Aspirin + Plavix
Multiple

sclerosis
 ↳
specific

→ j Ike
20-year-old female with transient vision loss
during sport, no other symptoms, MRI brain:
multiple demyelinating hyperintense lesion in
periventricular and white matter area, what is
the most likely diagnosis? Typical
↳ site for MS .

A- Multiple sclerosis
B- Brain lymphoma
C- Brain vasculitis
D- Neuropsychiatric SLE
The answer is A
Multiple sclerosis
Demyelination disease
Think in MS as a spot diagnosis in young age with multiple neurological
symptoms in different part of the body at a different time
Diagnosis:- MRI brain and spine (McDonald criteria) CSF analysis if done will
show Oligoclonal band IgG
Treatment:=
Acute exacerbation --> 1V Methylprednisolone
After resolution of attack you may give Interferon Beta (caution with liver disease
or depression) or Glatiramer

Young age patient with multiple neurological

symptoms in different parts of the body,
including eye symptoms and lower limb
weakness, what is the best diagnostic test?
A- EMG
B- NCV
C- MRI brain and spine
D- ECG
The answer is C
Multiple sclerosis
Demyelination disease
Think in MS as a spot diagnosis in young age with multiple neurological
symptoms in different part of the body at a different time
Diagnosis:- MRI brain and spine (McDonald criteria) CSF analysis if done will
show Oligoclonal band IgG
Treatment:=
Acute exacerbation --> 1V Methylprednisolone
After resolution of attack you may give Interferon Beta (caution with liver disease
or depression) or Glatiramer

Patient known to have multiple sclerosis came

to ER with acute episode of lower limb
weakness, which medication you will give?
A- Interferon
B- IV Corticosteroids
C- Oral steroid
D- IVIG
The answer is B
Multiple sclerosis
Demyelination disease
Think in MS as a spot diagnosis in young age with multiple neurological
symptoms in different part of the body at a different time
Diagnosis:- MRI brain and spine (McDonald criteria) CSF analysis if done will
show Oligoclonal band IgG
Treatment:=
Meningitis
 so Meningoencephalitis

res
like pneumonia

To avoid herniation
rp

Dexamethasone
→
Vancomycin ,
Ceftriaxone +

same TTT -1 Ampicillin > 50

-1

Alcoholic

or
aphasia

immunocompromised
=p
fungal infection
HIV
occurs in

Patient like

↳ RBCs
vs

↳ comorbidity in hx
 given only
in
strep.pro
to neurological consequences s &
mortality
of P
µ empirical TTT 8 Continue
only
in case strep .

→ Start with

→ Think of listeria monocytogenus in extreme age, pregnant, immunocompromised, alcoholic, and diabetic
Add ampicillin to the regimen

s ! 3

BEN %

meningitis

-
Not in pregnancy

Ll Teuton I '

Best
pregnancy
→ in

in general :

with papilla tenner ? vision toss

22-year-old female patient presented with meningeal irritation signs, CSF
showed: high WBCs, mainly lymphocyte, mildly elevated protein, normal level
of glucose, your most likely diagnosis?

A- Diabetic coma
B- TB meningitis
C- Viral meningitis
D- Bacterial meningitis

Man from India has fever, neck stiffness and photophobia, with high protein,
high lymphocytes and low glucose in CSF, what is this kind of meningitis?

A- Cryptococcus meningitis
B- Tuberculous meningitis
C- Viral meningitis
D- Aseptic meningitis

Pediatric patient presented with meningeal irritations signs and neck stiffness,
they did CT scan which showed: low attenuation of the tempoparietal area,
what is the most likely diagnosis?

A- Bacterial meningitis
B- Brain Abscess
C- HV meningitis
D- Cryptococcal meningitis
 Patient with neck stiffness and fever, CF analysis showed high protein, Low
glucose, high WBCs 70% polymorphs, what is the cause?

A- Cryptococcus neoformans
B- TB
C- Viral
D- Bacterial

In bacterial meningitis case, what do you expect to see on CSF analysis?

A- Normal glucose, High protein, Neutrophil predominance

B- Low glucose, High protein, Neutrophil predominance
C- Low glucose, High protein, Lymphocyte predominance
D- Normal glucose, High protein, Lymphocyte predominance

Case of meningitis, CF analysis showed picture of tuberculous meningitis with

high protein and low glucose, what will be the predominant type of cell?

A- Lymphocyte
B- Neutrophil
C-Eosinophil
D- Monocyte
What are the type of precaution in both meningitis and pneumonia?
A- Airborne → TB

B- Contact
C- Droplets
D- No precaution needed

How many hours after beginning antibiotics for meningitis the patient should
be isolated before discontinuing isolation?

A- 24 hours
B- 12 hours
C- 3 weeks
D- 3 days

51-year-old patient with fever, neck stiffness and photophobia, on examination:

positive kerning sign, CF gram stain showed gram +ve cocci in chains, what is
the causative agent? staph.it#-rept.p
to &
cluster chain

A- Streptococcus pneumoniae
B- Neisseria gonorrhea
C- Herpes simplex
D- Staphylococcus aureus
A case of meningitis and CSF showed +ve Coccobacillus, what is the organism?

A- H. Influanza→ gram-
ve Cocco bacilli

B- E. Coli
C- Listeria Monocytogenous
Think of listeria monocytogenus in extreme age, pregnant,
immunocompromised, alcoholic, and diabetic
Add ampicillin to the regimen

D- Neisseria meningitidis

34-year-old male developed meningitis after swimming in a river, what is the

most likely organism?

A- Naegleria fowleri
B- Streptococcus pneumoniae
C- Listeria monocytogenus
D- Staphylococcus aureus

22-year-old patient with typical symptoms of meningitis, culture showed gram

+ve cocci in chains, what is the appropriate treatment?
↳
strep P
.

A- Ceftriaxone, Vancomycin and Dexamethasone Think of listeria monocytogenus

in extreme age, pregnant,

B- Ceftriaxone, Vancomycin, Ampicillin and Dexamethasone → ist →

immunocompromised, alcoholic,
and diabetic
Add ampicillin to the regimen

C- Tazocine and Dexamethasone

D- Tazocine, Vancomycin and Dexamethasone
 Case od meningitis CF culture showed methicillin resistant staph aureus, which
type of antibiotics you should use?

A- Ceftriaxone
B- Vancomycin
C- Tazocine Does not
→ cross the BBB

D- Ciprofloxacin

m
encephalitis
A young male presented with altered sensorium, Fever and nuchal rigidity,
CSF analysis showed high protein, high WBCs but normal glucose, what is
viral ↳
the management?

A- Ceftriaxone + Vancomycin
B- Ampicillin
C- Acyclovir
D- Tazocine

Adult patient has contact with patient confirmed to has meningitis, which antibiotic
as a prophylaxis you should give?

A-Ciprofloxacin
B- Linezolid
C- Augmentin
D- Cefuroxime
Meningitis in child with picture showed petechia, what you should give to his
young brother as a prophylaxis?

A- Ciprofloxacin
B- Rifampin
C-Ceftriaxone
D- Ampicillin

Patient with meningitis, his sibling is allergic to the primary treatment given for
prophylaxis, what to give him as a prophylaxis?

A- Erythromycin
B- Vancomycin
C-Ceftriaxone
D- Cefuroxime

Late complication of meningitis?

A- Ataxia
B- Seizure
C- Deafness
D- Weakness
Epilepsy
Status epilepticus:
A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5
minutes period, without returning to a normal level of consciousness between
episodes

→
Better

↳ If not resolved → another IV

lorazepam + N
phenytoin .

↳ Resolved epilepticus
If not →
Refractory status .

Reassure
Eplipsy TTT is started after 2 epifsfe 24h far So in 1st time seizure =D
away .

↳ exception ① Pt with structural brain

:

deformity ②
family hx☆ ③ Patient with EGG
changed
.

↳ Anti
-
depressant
↳ smoking cessation
Acute exacerbation --> 1V Methylprednisolone
After resolution of attack you may give Interferon Beta (caution with liver disease
or depression) or Glatiramer

Patient came with seizure and History of

multiple sexual partners in past 6 years, what
investigation you will order?
A-HIV D- I
y
◦ I _↳¥
a
b

B- Syphilis Territory syphilis

→

C- Hepatitis B
D- Hepatitis C
The answer is B

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
A patient has a sudden onset of seizure, he is
medically free, has no family history of
epilepsy, and no history of recent infection, he
has never had any previous episodes of
seizures or loss of consciousness, he is not on
any medications, electrolytes and other blood
tests were all normal, what is the next
investigation that should be done for this
patient?
A- ECG Next step if the case syncopeis

B- EEG
C- Brain imaging
D- Lumbar puncture
The answer is C

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
20-year-old female presented to ER with status
epilepticus for 5 min, with IV access, what is
the first line?
A- IV Lorazepam
B- Diazepam rectal
C- Buccal midazolam ☐ if W access no

D- Oral Midazolam
The answer is A

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
25-year-old female known case of epilepsy
came with generalized tonic clonic seizure for
35 minutes and started on 20 mg IV lorazepam
but did not respond, what are you going to give
her next?
A- IV Phenytoin
B- IV Phenobarbital
C- IV Steroid
D- IV Fentanyl
The answer is A

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
Pediatric patient with manifestation of absence
seizure, what is the appropriate treatment?
A- Ethosuximide
B- Na valproate
C- Lamotrigine
D- Carbamazepine
The answer is A

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
Patient want to stop smoking, he has HTN and
epilepsy, what is the contraindicated drug?
A- Bupropion
B- Varenicline
C- Nicotine patch
D- Nicotine gum
The answer is A

Most common cause of seizure attack in epilepsy:- low AED level

Sleep deprivation is other cause
N.B: do not forget hypoglycemia as a cause of seizure attack
Absence seizure --> Ethosuximide
Generalized epilepsy --> Na valproate (but other can be used)
Safe in pregnancy -> Levetiracetam
N.B: note that some drugs can decrease seizure threshold such as Bupropion and
fluoroquinolone
Cranial nerve

injury
facial nerve a 7 "

to the tartan
Patient with facial asymmetry, moth deviation,
absence of forehead
wrinkles, what's the nerve affected?
A- 2nd
B- 5th
C- 7th
D- 10th
The answer is C
Patient has sudden onset unilateral facial
paralysis, which medication is proven to reduce
duration of symptoms?
A- Antiviral
B- Steroids
C- Antibiotic
D- IV fluid
The answer is B
Patient complaining of 4 months hearing loss,
now come with 7th cranial nerve palsy, what is
the most likely diagnosis?
A- Rumsy hunt
B- Brain tumor
C- Bell's palsy
The answer is A
loss of sensation in out 2/3 of tongue?
A- Trigeminal nerve
B- Facial nerve Remaining 113
C- Oculomotor nerve
D- Optic nerve
The answer is A
Patient with double vision, when he look
straight the left eye is deviated to nose side,
Left eye can not look laterally, which nerve is
affected? ipsilateral
A- Right 6th cranial nerve palsy
B- Right 3rd cranial nerve palsy
C- Left 6th cranial nerve palsy
D- Left 3rd cranial nerve palsy
The answer is C
55-year-old male known case of diabetes
mellitus presented complaining of ptosis,
inability to adduct, elevate and depress the
right eye, double vision when looking laterally
upon examination pupils are reactive
bilaterally, what is the most likely cause?
A- Posterior communicating artery aneurysm
B- Cavernous sinus thrombosis
C- 3rd nerve neuropathy
D- Myasthenia gravis
The answer is C
Parkinson

disease
 lab
↳ Results in chronic subdural hematoma
No or
image can
help

uses
vomiting
↳ in

↳
Antihypertensive uses
usually in
pregnancy

After 1 the
year → Dementia 5
Parkinsonism
-

I
tm 62 ooh levobpa I ☆
. . g @

Degeneration of which site in brain is the cause of Parkinson disease?

A- Basal ganglia
B- Cerebellum
C- Substantia nigra in midbrain
D- Cerebral hemisphere
70-year-old male came with Mask face,
bradykinesia, resting tremors, on examination:
shuffling gate, what is the diagnosis?
A- Acute stroke
B- Alzheimer disease
C- Parkinson disease
D- Age related changes
The answer is C
Parkinson disease
Degeneration of dopaminergic neuron in substantia nigra in midbrain

Clinical diagnosis, at least 2 of the following to diagnose:- bradykinesia,

cogwheel rigidity, resting tremor (asymmetric at onset), postural reflex
abnormality (falling)

Important to memorize medication induced parkinsonism (symmetrical at

onset):- Metoclopramide, Haloperidol and Methyldopa
N.B: Early dementia within the first year of the appearance of parkinsonism is a
hall mark of dementia with lewy body!
Treatment:- Levodopa with Carbidopa

Parkinson disease, how to reach the diagnosis?

A- Clinical diagnosis
B- CT brain
C- MRI brain
D- Lumbar puncture
The answer is A
Parkinson disease
Degeneration of dopaminergic neuron in substantia nigra in midbrain

Clinical diagnosis, at least 2 of the following to diagnose:- bradykinesia,

cogwheel rigidity, resting tremor (asymmetric at onset), postural reflex
abnormality (falling)

Important to memorize medication induced parkinsonism (symmetrical at

onset):- Metoclopramide, Haloperidol and Methyldopa
N.B: Early dementia within the first year of the appearance of parkinsonism is a
hall mark of dementia with lewy body!
Treatment:- Levodopa with Carbidopa

Patient with history of gastroenteritis took

medication, now came with abnormal
movements in head and eyes, what is the
causative drug?
A- Domperidone
B- Metoclopramide
C- Ciprofloxacin
D- Ceftriaxone
The answer is B
Parkinson disease
Degeneration of dopaminergic neuron in substantia nigra in midbrain

Clinical diagnosis, at least 2 of the following to diagnose:- bradykinesia,

cogwheel rigidity, resting tremor (asymmetric at onset), postural reflex
abnormality (falling)

Important to memorize medication induced parkinsonism (symmetrical at

onset):- Metoclopramide, Haloperidol and Methyldopa
N.B: Early dementia within the first year of the appearance of parkinsonism is a
hall mark of dementia with lewy body!
Treatment:- Levodopa with Carbidopa

Patient diagnosed with Parkinson disease, her

only complaint is right hand tremor that
disturbs her manual activities, which
medication to use?
A- Propranolol for essential tremor
→

B- Levodopa/Carbidopa
C- Amitriptyline
D- Sertraline
The answer is B
Parkinson disease
Degeneration of dopaminergic neuron in substantia nigra in midbrain
Dementia
 None of the
key words of other
types + %MʳᵈiZet atrophy of the brain
of dementia will be ment.my µ

m usually hyperintense

••

•
Memory loss then dementia

rp
violence or abnormal sexual behaviour

& 2 3 Tension

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Mwr

0£
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Alzehimer is exclusion + Brain atrophy

Neurology
70-year-old male patient known case of HTN
brought to ER by his son, his son reported that
patient had change in behaviors beside his
memory loss, he is fighting with every one in
the street, what is the most likely diagnosis?
A- Frontotemporal dementia
B- Dementia of Lewy body
C- Parkinson disease
D- Alzheimer disease
The answer is A
Old patient with signs of parkinsonism and also
mentioned visual hallucination, what is the
most likely diagnosis?
A- Alzheimer disease
B- Vascular dementia
C- Lewy body dementia
D- Frontotemporal dementia
The answer is C
Which vitamin deficiency can mimic dementia
symptoms?
A- Vitamin B2
B- Vitamin B9
C- Vitamin B12
D- Vitamin D
The answer is C
70-year-old male K/C of HTN with progressive
decline in cognitive state, MRI showed
Periventricular white matter Hyperintensities,
what is the diagnosis?
A- Vascular dementia
B- Alzheimer disease
C- Normal pressure hydrocephalus
The answer is A
Old male patient came with his brother, brother
complaining of change in personality, mild
forgetful, MRI show cortical atrophy, what is
the most likely diagnosis?
A- Normal tension hydrocephalus
B- Cruetzfelt jakob disease
C- Alzheimer disease conical
atrophy
→

D- Parkinson disease
The answer is C

In AbahimaF- the
personality changes are
Progressive

while in Frontotemporal dementia Personality changes are

acute
70-year-old male suspected to have Alzheimer
disease with memory loss for the last 1 year,
which of the following investigation we should
do it?
excuse
A- Brian imaging (MRI) → b- see the
atrophy
☐

B- EEG other

C- ECG
D- Skull x-ray
The answer is A
88-year-old male known case of HTN presented
with unsteady gait, later he developed
forgetfulness, what is the most likely
diagnosis?
A- Alzheimer disease
B- Frontotemporal dementia
C- Normal tension hydrocephalus
D- Cruetzfelt jakob disease
The answer is C

24-year-old male medically free had URTI 2

weeks ago and now developed back pain,
ascending lower limbs bilateral flaccid paralysis
spreads from the lower to the upper limbs in a
"stocking-glove" distribution and absent
reflexes, what is the most likely diagnosis?
A- Myasthenia gravis
B- Guillain-Barré syndrome
C- Brain tumor
D- Giant cell arteritis
The answer is B
Guillain Barre syndrome:
Acute ascending areflexic paralysis and paresthesia (distal to proximal) with
history of URTI or GLinfection (Campylobacter jeujeni) multiple weeks ago
Diagnosis:
Miscellaneous
A 45-year-old patient present to the clinic with
a three months history of stumbling weak grip,
dysphagia, generalized and lower limb
weakness, fatigability and tiredness and also
had 2 episodes aspiration pneumonia, has brisk
reflex and fasciculation, what is the most likely
diagnosis?
A- Amyotrophic lateral sclerosis end it
fatiagability
at the .

B- Myasthenia gravies Mr dayptosis

or

The .

C- Cerebral infarction → Aura

D- Gillian barre syndrome A- sensing Arfkxe

The answer is A
Amyotrophic lateral sclerosis

Combination of upper motor neuron sign (hyperreflexia, spasticity, and extensor

plantar response) with lower motor neuron signs (atrophy and fasciculation),
sensory deficit are absent
Can be associated with difficulty speaking and swallowing

Very poor prognosis

Old patient with history of recent travel, came

with difficulty getting aroused/awaken, he
report multiple falls, examination showed no
head wounds and skull is intact, what is the
most likely diagnosis?
A- Post-concussion syndrome
multiple falls
B- Chronic subdural hematoma old
age
→
+

C- Subarachnoid hemorrhage
D- Brain tumor
The answer is B
In pituitary adenoma, what is the vision
affection?
A- Homonymous hemianopia
B- Complete vision loss
C- Bitemporal hemianopia optic chiasma compression
→

D- Binasal hemianopia
The answer is C

Patient can localize the pain, open eye to pain,

say only sounds, what is the GCS level?
A- 8
B- 9
C- 10
D- 11
The answer is B
 2

Patient with head

'
injury, eye is opening to pain,

;
inappropriate words, abnormal flexion, how can
you consider this GCS level?
A- Mild
B- Moderate
C- Severe
The answer is C

inappropriate
sounds
inappropriate
or moaning

RTA patient eye respond to painful stimuli,

localize the pain, groaning sounds, calculate
GCS?
A- 8
B- 9
C- 10
D- 11
The answer is B
Patient have difficulty feeding can not put fork
to his mouth and had history of traffic accident,
where is the lesion?
A- Cerebellum
B- Cerebrum
C- Substantia nigari
D- Hippocampus
The answer is A