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Sample 1·Neurology
A 68-year-old presents 90 minutes after sudden right-sided weakness and aphasia. CT head shows no haemorrhage. Best next step?
- ✓IV thrombolysis with alteplase
- BAspirin 300mg only
- CWarfarin loading
- DMRI brain first
Explanation
Ischaemic stroke within 4.5h with no contraindication: IV alteplase reduces disability. Do not delay for MRI.
Sample 2·Neurology
A 50-year-old presents with progressive proximal weakness, hyperreflexia and fasciculations. Sensation is intact. Diagnosis?
- AGuillain-Barré syndrome
- ✓Motor neurone disease
- CMultiple sclerosis
- DMyasthenia gravis
Explanation
MND: mixed UMN and LMN signs with fasciculations, preserved sensation and sphincter function.
Sample 3·Neurology
A 25-year-old presents with sudden severe occipital headache described as 'worst ever'. CT head is normal 8 hours later. Best next step?
- AMRI brain
- ✓Lumbar puncture
- CDischarge with analgesia
- DCT angiogram
Explanation
If CT is negative >6 h from onset in suspected SAH, LP for xanthochromia at ≥12 h is required.
Sample 4·Neurology
A 65-year-old has a right-sided homonymous hemianopia after a stroke. The lesion is most likely in which vascular territory?
- ARight posterior cerebral artery
- BLeft middle cerebral artery
- ✓Left posterior cerebral artery
- DRight anterior cerebral artery
Explanation
Right homonymous hemianopia results from left occipital lobe/PCA territory infarct.
Sample 5·Neurology
A 30-year-old woman has episodic unilateral throbbing headaches preceded by visual zigzag lines lasting 20 minutes. Diagnosis?
- ACluster headache
- ✓Migraine with aura
- CTension headache
- DTrigeminal neuralgia
Explanation
Migraine with aura: reversible visual/sensory symptoms lasting 5–60 min preceding unilateral headache.