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Which of the following is caused by a lesion of the occipital lobe? (Please select 1 option) Acalculia Astereognosis Constructional apraxia Cortical blindness Correct Visuospatial neglect Lesions of the frontal lobe include difficulties with task sequencing and executive skills:
    

Expressive aphasia (receptive aphasias a temporal lobe lesion) Primitive reflexes Perseveration (repeatedly asking the same question or performing the same task) Anosmia Changes in personality.

Lesions of the parietal lobe include:
   

Apraxias Neglect Astereognosis (unable to recognise an object by feeling it) Visual field defects (typically homonymous inferior quadrantanopia).

They may also cause acalculia (inability to perform mental arithmetic). Lesions of the temporal lobe cause:
   

Visual field defects (typically homonymous superior quadrantanopia) Wernicke's (receptive) aphasia Auditory agnosia Memory impairment.

Occipital lobe lesions include:

Cortical blindness (blindness due to damage to the visual cortex and may present as Anton syndrome where there is blindness but the patient is unaware or denies blindness) Homonymous hemianopia

The corpus callosum can be involved in multiple sclerosis where socalled Dawson's fingers can be seen. He is currently on aspirin. parahippocampus Incorrect answer selected Orbitofrontal cortex and anterior cingulate This is the correct answer Prefrontal cortex and anterior thalamic nucleus Damage to the hippocampus and parahippocampus results in memory problems and has early involvement in Alzheimer's disease. amlodipine and hydrochlorothiazide. hypertension. hypercholesterolaemia. Prefrontal cortex damage can result in disinhibition and problems with social interaction and judgement and has been implicated in schizophrenia.it is different from neglect. since in agnosia the objects are seen and followed but cannot be named). He has a history of diabetes. 3) A 70-year-old man presents with difficulty speaking. chronic obstructive pulmonary disease. 2) Imaging changes in frontotemporal dementia (FTD) start initially in which parts of the brain? (Please select 1 option) Corpus callosum Dorsolateral prefrontal cortex and anterior cingulate Hippocampus. simvastatin. Visual agnosia (seeing but not perceiving objects . .

He is unable to identify it by name and appears frustrated. he is able to do so. It localises to the dominant superior temporal gyrus. repetition and understanding. He is shown a pen and asked what it is. When told to raise his arms and place his hands out he is seen to have a pronator drift on the right. applying much effort to speak a sentence. Global aphasia results in an almost mute patient: there is poor verbal output. His pulse is irregularly irregular. With what type of dysphasia is this consistent? (Please select 1 option) Broca's aphasia Global aphasia Transcortical motor aphasia Correct Transcortical sensory aphasia Wernicke's aphasia In Broca's or non-fluent or expressive aphasia the patient is unable to name objects with poor comprehension and repetition. There is poor comprehension and repetition but verbal output is fluent. his blood pressure is 150/70 mmHg. . He has 4/5 strength on the right arm and leg and 5/5 strength on the left. comprehension. It localises to the Broca's area in the left posterior inferior frontal gyrus. In Wernicke's or fluent or receptive aphasia the patient is able to form correct grammatical sentences but language content is incorrect. When asked to point to the window he does this correctly. He is asked to use it appropriately and begins to write on a piece of paper but no makes no legible words despite being a retired journalist. When asked to repeat 'Today is a sunny day'.On examination the patient is awake. 4)A 40-year-old male presents to casualty with weakness and paraesthesia of the right arm and leg. Transcortical sensory aphasia is similar to transcortical motor aphasia in that there is good repetition but comprehension and fluency are poor.

and recurrence of the headache suggests extension or recurrence of the dissection. The patient is afebrile. if there is mono or hemiparesis with normal mental state. or basilar skull fracture in a patient with altered mental status. The combination of MRI and MRA is more reliable in detecting dissection than either modality alone. and evaluating intracranial arteries. Additionally in the absence of arteriography. as well as syncope and amaurosis fugax. and blood results are normal. This rare finding may lead to a . detecting emboli. Headache is commonly ipsilateral to the side of the carotid dissection. However limitations of duplex scanning include difficulties of scanning the distal internal carotid artery. As it is the most accurate study and the current gold standard for diagnosis of carotid artery dissection. signs or history of major cervical trauma with abnormal neurology. as xanthochromia may occur when a haematoma propagates. What is the single best investigation of choice? (Please select 1 option) Contrast arteriography This is the correct answer CT head Duplex scanning of the neck vessels Incorrect answer selected Lumbar puncture MRI brain Ischaemic neurological features (transient or completed strokes) are found in 30-80% of patients presenting with carotid artery dissection.The symptoms developed 12 hours after the onset of a piercing left sided headache. Lumbar puncture results may be misleading. Kernig's sign is negative. but there is a pain in the left side of the neck and occiput. There is no neck stiffness. duplex scanning or MRI with MRA may be considered the next best tests. Obviously in practice many trusts will require a CT head first. Pulsatile tinnitus is common. contrast arteriography should be strongly considered.

misdiagnosis of subarachnoid haemorrhage and failure to perform further carotid workup. measurement of insulin and C peptide will be needed to confirm the diagnosis. one would wish to exclude possible drug administration and although not mentioned here. The appropriate cortisol response during his hypoglycaemic episode (cortisol 800) excludes hypoadrenalism. is not diabetic and therefore should not have received insulin or a sulphonylurea. a prolonged fast is required and should he develop hypoglycaemia. A serum cortisol concentration later returns as 800 nmol/l (120600). However. a sulphonylurea screen should be undertaken. He does not have diabetes. Similarly. and has no other significant past medical history. He has presented with symptomatic hypoglycaemia. Which of the following would be the most relevant investigation for this man? (Please select 1 option) Chest x ray CT head scan Electrocardiogram Prolonged 72 hour fast This is the correct answer Short Synacthen test Incorrect answer selected The historical and biochemical evidence here suggests a diagnosis of spontaneous hypoglycaemia. and the most likely cause would be an insulinoma.0 mmol/l. His blood glucose is recorded as 1. there is nothing to suggest sepsis. However. . There is nothing to suggest alcohol or drug misuse. 5) 78-year-old male is brought to the Emergency department and has a witnessed seizure in the resuscitation room. He is given 50 ml of 50% dextrose and he slowly recovers over the next one hour. to prove a diagnosis of spontaneous hypoglycaemia.

On examination he was febrile with marked neck stiffness. penicillin-resistant pneumococcus): Cefotaxime (+ vancomycin if susceptibility to broad-spectrum cephalosporins reduced) Neisseria meningitidis: Benzylpenicillin (penicillin G) Haemophilus influenzae: Cefotaxime Listeria monocytogenes: Ampicillin + gentamicin Group B streptococcus: Benzylpenicillin (penicillin G).06 µgrams/mL: Benzylpenicillin (penicillin G) or cefotaxime o If penicillin MIC >0. Investigations revealed: Cerebrospinal fluid analysis (normal ranges are shown in brackets): 600/ml (<5) White cell count White cell differential >90% Neutrophils Gram-negative diplococci Gram stain Which one of the following antibiotics.A 45-year-old man presented with a three day history of headache and increasing confusion. .     A 45-year-old man presented with a three day history of headache and increasing confusion. given intravenously.1 µgrams/ml (that is. is the most appropriate treatment? (Please select 1 option) Ampicillin Benzylpenicillin Cefuroxime Ciprofloxacin Gentamicin This is clearly a case of meningococcal meningitis. On the basis of CSF culture:  Streptococcus pneumoniae  o If penicillin MIC <0. The commonest causes of bacterial meningitis in adults are:   Neisseria meningitidis (Gram negative diplococci) Streptococcus pneumoniae (Gram positive diplococci). This is the correct answer Incorrect answer selected Treatment of bacterial meningitis On the basis of Gram stain results:      Gram stain unavailable or no stainable organisms: Cefotaxime ± ampicillin Gram positive cocci: Cefotaxime + vancomycin Gram positive bacilli: Ampicillin + gentamicin Gram negative cocci: Benzylpenicillin (penicillin G) Gram negative bacilli: Cefotaxime + gentamicin.

On examination he was febrile with marked neck stiffness. This is the correct answer Incorrect answer selected Treatment of bacterial meningitis On the basis of Gram stain results:      Gram stain unavailable or no stainable organisms: Cefotaxime ± ampicillin Gram positive cocci: Cefotaxime + vancomycin Gram positive bacilli: Ampicillin + gentamicin Gram negative cocci: Benzylpenicillin (penicillin G) Gram negative bacilli: Cefotaxime + gentamicin. is the most appropriate treatment? (Please select 1 option) Ampicillin Benzylpenicillin Cefuroxime Ciprofloxacin Gentamicin This is clearly a case of meningococcal meningitis.06 µgrams/mL: Benzylpenicillin (penicillin G) or cefotaxime o If penicillin MIC >0. Investigations revealed: Cerebrospinal fluid analysis (normal ranges are shown in brackets): 600/ml (<5) White cell count White cell differential >90% Neutrophils Gram-negative diplococci Gram stain Which one of the following antibiotics.1 µgrams/ml (that is.     . penicillin-resistant pneumococcus): Cefotaxime (+ vancomycin if susceptibility to broad-spectrum cephalosporins reduced) Neisseria meningitidis: Benzylpenicillin (penicillin G) Haemophilus influenzae: Cefotaxime Listeria monocytogenes: Ampicillin + gentamicin Group B streptococcus: Benzylpenicillin (penicillin G). The commonest causes of bacterial meningitis in adults are:   Neisseria meningitidis (Gram negative diplococci) Streptococcus pneumoniae (Gram positive diplococci). given intravenously. On the basis of CSF culture:  Streptococcus pneumoniae  o If penicillin MIC <0.

Intraneuronal NA is usually taken back up into the neurosecretory granules and a small amount is metabolised by monoamine oxidase (MAO).MRCP Part 1 Question: 9 of 10 Time taken: 18:17 The action of noradrenaline (NA) released at sympathetic nerve endings is terminated by which of the following? (Please select 1 option) Enzymatic decarboxylation Enzymatic inactivation by catechol-O-methyl transferase Oxidative deamination by monoamine oxidase Incorrect answer selected Removal by the circulating blood Re-uptake of noradrenaline by the axonal terminals This is the correct answer A popular question for the examination but simple physiology gets the right answer here. Which one of the following drugs is most likely to be responsible for her symptoms? (Please select 1 option) Carbamazepine Lamotrigine Phenytoin Incorrect answer selected Sodium valproate This is the correct answer Topiramate . Work Smart Session . The effects of neurotransmitter release are principally terminated by neuronal uptake.Work Smart Session . some hair loss and a tremor six months after commencing single drug treatment.MRCP Part 1 Question: 7 of 10 Time taken: 09:09 A 30-year-old female presents with weight gain. Even smaller quantities that escape into the circulation are metabolised by catechol-Omethyltransferase (COMT).

Phenytoin is associated with:       Peripheral neuropathy Cerebellum syndrome Acne Hirsutism Gingival hypertrophy Hypocalcaemia. Topiramate is associated with:     Renal stones Weight loss Cognitive impairment Tingling in extremities. Work Smart Session .Sodium valproate is associated with:      Weight gain Tremor Hair loss Teratogenicity Polycystic ovary disease.MRCP Part 1 Question: 9 of 10 Time taken: 06:28 Which of the following is caused by a lesion of the frontal lobe? (Please select 1 option) Apraxia Broca's (expressive) aphasia Correct Cortical blindness Homonymous hemianopia Visuospatial neglect Lesions of the frontal lobe include:   Difficulties with task sequencing and executive skills Expressive aphasia (receptive aphasias and temporal lobe lesion) . Lamotrigine is associated with skin rash (and Stevens-Johnson syndrome in severe cases).

They may also cause alcalculia (inability to perform mental arithmetic). Lesions of the temporal lobe cause:     Visual field defects (typically homonymous superior quadrantanopia) Wernicke's (receptive) aphasia Auditory agnosia Memory impairment. Lesions of the parietal lobe include:     Apraxias Neglect Astereognosis (unable to recognise an object by feeling it) Visual field defects (typically homonymous inferior quadrantanopia). .    Primitive reflexes Perseveration (repeatedly asking the same question or performing the same task) Anosmia Changes in personality. Occipital lobe lesions include:    Cortical blindness (blindness due to damage to the visual cortex and may present as Anton syndrome where there is blindness but the patient is unaware or denies blindness) Homonymous hemianopia Visual agnosia (seeing but not perceiving objects .it is different to neglect since in agnosia the objects are seen and followed but cannot be named).