Neurology Module July 2022 MRCP Part-1

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Question 1 of 606

1. Question
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Category: Neurology Module July 2022 MRCP Part-1
A 28-year-old lady presents to the outpatient clinic with complaint of headaches. She has a severe frontal and occipital headache which is present as soon as she wakes up in the mornings. She had given birth to a baby girl one month previously and has not been feeling well since.

Examination revealed bilateral blurring of the optic discs with a pupil sparing third nerve palsy on the left.
Which one of the following is the most plausible diagnosis?
- Sphenoidal wing meningioma.
- Sagittal sinus thrombosis.
- Meningococcal meningitis.
- Brainstem cerebrovascular accident (CVA).
- Herpes simplex virus (HSV) encephalitis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 2 of 606

2. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 19-year-old lady develops sudden onset of a severe headache.

She is opening her eyes spontaneously. She is disoriented but is localising to painful stimuli.

Which one of the following is the most congruous initial investigation?
- Magnetic resonance imaging (MRI).
- Magnetic resonance angiography (MRA).
- Computed tomography (CT) scan.
- Lumbar puncture (LP).
- Positron emission tomography (PET) scan.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 3 of 606

3. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 57-year-old gentleman noticed tinnitus in his right ear which progressed over some weeks to hearing loss in that ear.

On physical examination he is found to have a marked decrease in hearing on the right, with Rinne Test indicating air conduction better than bone conduction. The other cranial nerves I – VII and IX – XII are intact.

Brain magnetic resonance imaging (MRI) scan revealed a solitary, fairly discrete 2.5 cm mass located in the region of the right cerebellopontine angle.

Which one of the following statements is most apposite to tell the gentleman regarding these findings?
- He is unlikely to survive for more than a year.
- Remissions and exacerbations are likely to occur in coming years.
- A test for HIV-1 is likely to be positive.
- The lesion can be resected with a good prognosis.
- Other family members should undergo MR imaging of the brain.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 4 of 606

4. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 35-year-old lady has presented to the Emergency Department for the fourth time with abdominal pain which typically lasts for several days. On the previous three occasions she has been discharged home without a firm diagnosis. Between episodes, she is symptom-free. She complains of feeling anxious.

She has recently restarted the combined oral contraceptive pill after completing her family.

On examination, she is anxious and hypertensive at 160/100 mmHg with a pulse of 105 beats per minute. She has no rashes. Her abdomen is diffusely tender.

Investigations Show:

Haemoglobin	130 g/L	(135-180)
White Blood Cell Count	8.4 ×10⁹/L	(4-10)
Platelet Count	235 ×10⁹/L	(150-400)
Serum Sodium	137 mmol/L	(134-143)
Serum Potassium	4.1 mmol/L	(3.5-5)
Serum Creatinine	98 μmol/L	(60-120)

Which one of the following is the most likely diagnosis?

Acute intermittent porphyria.
Porphyria cutanea tarda.
Variegate porphyria.
Depression.
Appendicitis.

Correct

Incorrect

Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 5 of 606

5. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 52-year-old lady with diabetes is referred from the Emergency Department complaining of dizziness and vomiting.

On examination, she is alert and orientated, her pulse rate is 80 beats per minute and irregularly irregular and blood pressure is 165/94 mmHg. There is nystagmus on right lateral gaze and her speech is slurred. On examination of the limbs, intention tremor is noted and past pointing. She is ataxic when mobilised.

Which one of the following is the most likely diagnosis?
- Subacute combined degeneration of the cord.
- Wernicke’s encephalopathy.
- Cerebellar cerebrovascular accident (CVA).
- Viral labyrinthitis.
- Brainstem infarction.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 6 of 606

6. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 51-year-old gentleman with a prolonged history of alcohol excess presents with a four-day history of deteriorating confusion.

On examination, he is drowsy, has a temperature of 102.2°F, a pulse rate of 100 beats per minute, a small amount of ascites and has features of a right side hemiparesis.

Which one of the following is the most proper diagnosis?
- Hepatic encephalopathy.
- Cerebral abscess.
- Subdural haematoma.
- Wernicke's encephalopathy.
- Cerebrovascular accident (CVA).
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 7 of 606

7. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 31-year-old gentleman presented with an eight-month history of depression, irritability and painful sensory symptoms in his legs. Over the last one month he presents a broad base ataxic gait.

Magnetic resonance imaging (MRI) scan of brain showed bilateral posterior thalamic nuclei (pulvinar region) high signals.

Which one of the following is the most likely diagnosis?
- Multiple system atrophy.
- Herpes simplex encephalitis.
- Sporadic Creutzfeldt-Jakob disease (CJD).
- Wilson disease.
- New variant Creutzfeldt-Jakob disease (CJD).
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 8 of 606

8. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 33-year-old gentleman presents with weakening of the right side of his face and an inability to close his right eye. He had a viral illness in the preceding week. There is no past medical history of note.

On examination, there is a right VIIth nerve palsy. The remaining cranial nerves are normal. Power, tone and reflexes are normal in the limbs.

Which one of the following is the best course of treatment?
- No treatment is required.
- Oral augmentin.
- Oral prednisolone.
- Oral valaciclovir and prednisolone.
- Intravenous immunoglobulin.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 9 of 606

9. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 68-year-old lady presents to the Emergency Department with a left-sided facial palsy affecting the whole of the left side of her face.

Which one of the following is the most likely cause of this presentation?
- Left-sided seventh nerve palsy.
- Left-sided fifth nerve palsy.
- Right-sided infarct affecting the internal capsule.
- Right-sided infarct affecting the internal capsule.
- Left-sided infarct affecting the frontal lobe.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 10 of 606

10. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 66-year-old lady attends the Emergency Department with right-sided weakness.

Over the next hour her symptoms resolve, and after three hours she is feeling completely back to normal.

Which one of the following is the best course of action to be taken?
- Discharge and general physician follow up.
- Urgent computed tomography (CT) of head and carotid duplex whilst inpatient.
- Urgent carotid endarterectomy.
- Discharge and follow up the next day in transient ischaemic attack (TIA) clinic.
- Discharge and see in stroke clinic in 3 months.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 11 of 606

11. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

An 81-year-old gentleman was admitted in a confused state.

He has a history of immobility due to severe lower back pain. He had been losing weight for five months and had complaints of weakness, urinary frequency, thirst, poor urinary stream and constipation.

Lumbar spine x-rays show severe osteopenia and collapse of the body of the vertebra at L3.

Investigations Show:

Haemoglobin	100 g/L	(130-180)
Serum Sodium	142 mmol/L	(137-144)
Serum Potassium	4.1 mmol/L	(3.5-4.9)
Serum Urea	10.2 mmol/L	(2.5-7.5)
Serum Creatinine	115 μmol/L	(60-110)
Plasma Glucose	6 mmol/L	(3.0-6.0)
Dipstick Urine	Blood ++; Protein +

Which one of the following is the most important immediate investigation?

Magnetic resonance imaging (MRI) scan whole spine.
Serum calcium.
Prostate specific antigen.
Chest x-ray.
Serum protein electrophoresis.

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 12 of 606

12. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which area whose sensation is supplied by the median nerve will be spared if the nerve is compressed at the carpal tunnel?
- Skin over the hypothenar eminence.
- Skin over the volar surface of the hand.
- Skin over the thenar eminence.
- Skin over the medial two digits.
- Skin over the lateral three digits.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 13 of 606

13. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following anatomical considerations is correct?
- In cortical blindness pupillary reactions are abnormal.
- Optic tract lesions produce an ipsilateral homonymous hemianopia.
- The physiological blind spot is unaffected by papilloedema.
- Midline cerebellar lesions cause marked horizontal nystagmus.
- Optic chiasm lesions characteristically produce a bitemporal hemianopia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 14 of 606

14. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 74-year-old lady presents with difficulty speaking.

She has a longstanding history of diabetes, hypertension, hypercholesterolaemia and chronic obstructive pulmonary disease. She is currently on aspirin, simvastatin, amlodipine and hydrochlorothiazide.

On examination, she is awake, her blood pressure is 155/75 mmHg. Her pulse is irregularly irregular. She has 4/5 strength in the left arm and leg and 5/5 strength on the right. When asked to point to the window she does this correctly.

When told to raise her arms and place her hands out she is seen to have a pronator drift on the left. She is shown a pencil and is asked to identify it. She is unable to identify it by name and appears frustrated: applying much effort to speak a sentence. She is asked to use it appropriately and begins to write on a piece of paper but she makes no legible words despite being a retired content writer. When asked to repeat ‘Today is a sunny day’, she is unable to do so.

With which one of the following is this type of dysphasia consistent?
- Broca's aphasia.
- Wernicke's aphasia.
- Transcortical sensory aphasia.
- Global aphasia.
- Transcortical motor aphasia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 15 of 606

15. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following would be expected following distal occlusion of the posterior cerebral artery?
- Dysarthria.
- Cerebellar ataxia.
- Contralateral hemiplegia.
- Homonymous hemianopia.
- Palatal palsy.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 16 of 606

16. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A computed tomography (CT) scan shows blood in the Sylvian fissure.

In which one of the following compartments is this blood?
- Subarachnoid.
- Subgaleal.
- Subdural.
- Epidural.
- Subcortical.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 17 of 606

17. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 54-year-old lady has a history of progressive weakness for six weeks. She had particular difficulty getting out of the bath.

On examination there was severe truncal and proximal limb weakness, without wasting or fasciculation.

Tendon reflexes, plantar responses and sensation were all normal.

The vital capacity was 1.8L.

Which one of the following is the most pertinent diagnosis?
- Guillain-Barré syndrome.
- Polymyositis.
- Polio.
- Syringobulbia.
- Cervical myelitis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 18 of 606

18. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Regarding herpes simplex virus (HSV) encephalitis, which one of the following assertions is correct?
- Fits are uncommon.
- Magnetic resonance imaging (MRI) scan of brain is characteristically normal.
- Temporal lobe involvement is common.
- Viral identification using polymerase chain reaction (PCR) on CSF is non-specific.
- Genital herpes is usually present.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 19 of 606

19. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 59-year-old lady presents to the Emergency Department having had a fall.

Examination revealed ataxia and some mild extrapyramidal signs. She was receiving treatment for suspected Parkinson’s disease following a fall she had had eight months ago when she demonstrated extrapyramidal signs. Her symptoms had been noted to have improved with the medication. Tilt table testing was performed and found to be positive.

Which one of the following is the most reasonable diagnosis?
- Wilson's disease.
- Postural hypotension.
- Parkinson's disease.
- Cerebellar degeneration.
- Multi-system atrophy.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 20 of 606

20. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 37-year-old gentleman presents with problems seeing for the past three days.

He reports that the vision of his right eye is much worse than normal for the last three days. He reports that he woke up and thought there was something in his eye but the vision is getting worse. He denies diplopia but has blurred vision.

On examination his visual acuity is 20/20 in the left eye and finger counting only in the right. There is red desaturation and a relative afferent papillary defect. His past medical history is unremarkable and he reports never having had neurological symptoms in the past.

On examination of his fundus, which one of the following is the most likely finding?
- Cupped disc.
- Normal optic disc.
- Optic atrophy.
- Macular star.
- Papilloedema.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 21 of 606

21. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 27-year-old lady presents with vague frontal headaches and visual disturbance.

She has a past history of acne for which she is receiving treatment. Examination reveals her to be obese with a blood pressure of 115/74 mmHg. There is absence of the central retinal vein pulsation on fundoscopic examination.

Which one of the following drugs is responsible for this presentation?
- Ampicillin.
- Erythromycin.
- Isotretinoin.
- Dianette.
- Topical tetracycline.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 22 of 606

22. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 61-year-old gentleman with multiple sclerosis is treated for severe hip adductor muscle spasticity and three days later he develops diplopia.

Which one of the following treatments is he likely to have been given?
- Botulinum toxin.
- Intrathecal baclofen.
- Tizanidine.
- Dantrolene.
- Oral baclofen.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 23 of 606

23. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 68-year-old lady is brought to the outpatient clinic by her husband. He is no longer able to manage her urinary incontinence.

She was diagnosed with Parkinson’s disease by her general physician a few years ago when she became slow and shuffling and used to struggle to get to the toilet in time. Her husband says that she ‘lost a lot of the warning’ from her bladder and would sometimes be incontinent. However, her husband says she now no longer seems to care whether she is being incontinent of urine or not. He admits that she has been ‘forgetful’ for a few years but that this is also getting much worse.

Which one of the following is the most congruent diagnosis?
- Lewy body dementia.
- Alzheimer's dementia.
- Parkinson's plus syndrome.
- Obstructive uropathy.
- Normal pressure hydrocephalus.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 24 of 606

24. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 69-year-old gentleman attends the Emergency Department with a stroke affecting his right arm and leg. He has no features of disability.

A computed tomography (CT) scan confirms that there is a left cerebrovascular accident (CVA). Carotid scanning shows stenosis of 80% on the left and 90% on the right.

Which one of the following is the best course of action?
- Bilateral carotid endarterectomy.
- Urgent carotid endarterectomy on the right.
- Urgent carotid endarterectomy on the left.
- Discharge and general physician follow up.
- Discharge and outpatient follow up.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 25 of 606

25. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 21-year-old lady presents to the antenatal clinic.

She is approximately four weeks pregnant and the pregnancy was unplanned. She has a three-year history of grand mal epilepsy for which she takes carbamazepine. She has had no fits for approximately five months. She wants to continue with her pregnancy if it is safe to do so.

She is anxious about the anticonvulsant therapy and its effects on the baby. She wants to know how she should be managed.

Which one of the following management plans is the most concordant in this case?
- Switch therapy to sodium valproate.
- Continue with carbamazepine.
- Switch therapy to phenytoin.
- Stop carbamazepine until the second trimester.
- Advise termination due to drug teratogenicity.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 26 of 606

26. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 47-year-old lady presents with a three-year history of intermittent strictly unilateral headaches.

The pain is extremely severe. It is located around the orbital region. The headache usually lasts for 50 – 60 minutes. It usually occurs in the early hours of the morning.

There is associated ptosis and lacrimation on the side of the headache.

Which one of the following is the most proper diagnosis?
- Giant cell arteritis.
- Tension type headache.
- Trigeminal neuralgia.
- Migraine.
- Cluster headaches.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 27 of 606

27. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 32-year-old lady presents with a four month history of difficulty walking.

Examination reveals motor weakness of right leg in a pyramidal distribution with increase in tone. There is impaired pinprick sensation of left leg extending into the groin.

Which one of the following is most likely the cause of this presentation?
- Bilateral cerebral hemisphere lesions.
- A central cauda equina lesion.
- A left-sided thoracic spinal cord lesion.
- A foramen magnum lesion.
- A cervical spinal cord lesion.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 28 of 606

28. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 51-year-old lady presents with a resting tremor of her left arm and a diagnosis of idiopathic Parkinson’s disease is made.

Which one of the following drugs is most likely to help her tremor?
- Benzhexol.
- Amantadine.
- Cabergoline.
- Selegiline.
- Co-careldopa.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 29 of 606

29. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following statements about the spinal cord is true?
- Centrally placed spinal cord lesions affect joint position sense before other modalities of sensation.
- The spinal cord ends at the lower border of the L3 vertebra.
- Conus medullaris lesions cause lower motor neurone signs with absent reflexes.
- The spinothalamic tracts are supplied principally by the anterior spinal artery.
- A lesion of the left side of the spinal cord at C5 causes pyramidal weakness of the right leg.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 30 of 606

30. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 47-year-old gentleman presents to the Emergency Department.

His wife says he has not been himself for the past few days, becoming aggressive over insignificant things and yesterday he could not work out how to use the TV remote control. When she confronted him he told her that he had a headache. Today she found him in the kitchen picking at his clothes and smacking his lips. He would not respond to her when she called him. This lasted for a few minutes. Afterwards he was confused and unable to remember this episode.

On examination, his temperature is 100°F and he is becoming increasingly drowsy. Blood tests show a leucocytosis.

Which one of the following is the most likely diagnosis?
- Bacterial meningitis.
- Drug overdose
- Subdural haemorrhage.
- Listeria rhombencephalitis.
- Herpes simplex virus (HSV) encephalitis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 31 of 606

31. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 37-year-old gentleman was recently diagnosed with rheumatoid arthritis.

He has developed weakness, diplopia and tiredness.

Examination reveals bilateral weakness of eye abduction, bilateral ptosis, slightly reduced proximal motor power in the limbs, normal reflexes and sensation.

Which one of the following is the most pertinent diagnosis?
- Chronic progressive external ophthalmoplegia.
- Myasthenia gravis.
- Polymyositis.
- Guillain-Barré syndrome.
- Multiple sclerosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 32 of 606

32. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 72-year-old lady presents with one-year history of cognitive impairment, Parkinsonism, intermittent confusion and generalised myoclonus.

She was started on sinemet 62.5 mg three times daily. In the following three months she has started experiencing visual hallucinations.

Which one of the following is the most proper diagnosis?
- Idiopathic Parkinson's disease.
- Multiple system atrophy.
- Diffuse Lewy body disease.
- Progressive supranuclear palsy.
- Alzheimer's disease.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 33 of 606

33. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 48-year-old lady presents with an insidious onset of binocular horizontal diplopia and right-sided facial pain.

On examination she has a right abducens nerve palsy and numbness over the maxillary division of the right trigeminal nerve.

Of the following, which one is the most likely anatomical site of her neurological lesion?
- Midbrain.
- Superior orbital fissure.
- Cavernous sinus.
- Petrous apex.
- Cerebellopontine angle.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 34 of 606

34. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 47-year-old gentleman is referred to the Emergency Department with bilateral weakness in his legs. He also complains of generalised malaise.

A month ago he had returned from a three-week tour of Western Europe.

On examination, he appeared unwell and was pyrexial (102°F). He has large palpable cervical lymph nodes bilaterally. His pharynx was inflamed with areas of exudate on the pharyngeal wall. Neurological examination revealed global weakness of both legs and absent reflexes.

Which one of the following is the most anticipated diagnosis?
- Diphtheria.
- Epstein-Barr virus infection.
- Hodgkin’s disease.
- Streptococcal tonsillitis.
- Cytomegalovirus infection.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 35 of 606

35. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following factors decreases large intestinal motility?
- Gastric distension.
- Anticholinergic agents.
- Parasympathetic activity.
- CCK-PZ (cholecystokinin).
- Laxatives.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 36 of 606

36. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 65-year-old lady presents with difficulty speaking.

She has a history of diabetes, hypertension, hypercholesterolaemia, chronic obstructive pulmonary disease. She is currently on aspirin, simvastatin, amlodipine and hydrochlorothiazide.

On examination the she is awake, her blood pressure is 148/72 mmHg. Her pulse is irregularly irregular. She has 4/5 strength on the left arm and leg and 5/5 strength on the right.

When she was asked to point to the window she appears unable to do so. When told to raise her arms and place her hands out she does not. When visually shown the same action she is able to perform it. When asked to repeat ‘Today is a rainy day’, she is able to do so.

This type of dysphasia is consistent with which one of the following?
- Broca's aphasia.
- Wernicke's aphasia.
- Transcortical sensory aphasia.
- Global aphasia.
- Transcortical motor aphasia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 37 of 606

37. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following relates to dopa-decarboxylase inhibitors?
- Reduce the extracerebral complications of L-dopa therapy.
- Enhance the effect of levodopa on the substantia nigra.
- Prevent L-dopa associated dyskinesias.
- Should not be given in combination with dopamine agonists.
- Have anticholinergic activity.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 38 of 606

38. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 69-year-old lady is brought to the Emergency Department with a sudden onset of ataxia, vomiting and headache, followed by increasing drowsiness.

Which one of the following is the most plausible diagnosis?
- Frontal subdural empyema.
- Herpes simplex encephalitis.
- Acute cerebellar haemorrhage.
- Pituitary apoplexy.
- Acute subdural haemorrhage.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 39 of 606

39. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 38-year-old lady presented with a one-day history of blurred vision in the right eye and mild right frontal headache. She had an eight year history of diabetes mellitus.

Examination of the right eye revealed a central scotoma.

Which one of the following is the most proper diagnosis?
- Pituitary tumour.
- Optic neuritis.
- Central retinal artery occlusion.
- Diabetic retinopathy.
- Migraine.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 40 of 606

40. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 44-year-old lady presents to her general physician with a three week history of numbness and a burning sensation on the lateral aspect of the right upper thigh.

Examination reveals sensory loss over the anterolateral thigh.

Which one of the following nerves is most likely to be involved in this lady?
- Lateral cutaneous nerve of the thigh.
- Femoral nerve.
- Obturator nerve.
- L2 nerve root.
- L3 nerve root.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 41 of 606

41. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
An 80-year-old gentleman attends the Emergency Department with amaurosis fugax on the right.

Carotid scanning shows stenosis of 80% on the left and 90% on the right.

Which one of the following is the best course of action to be taken?
- Discharge and general physician follow up.
- Discharge and outpatient follow up.
- Bilateral carotid endarterectomy.
- Urgent carotid endarterectomy on the left.
- Urgent carotid endarterectomy on the right.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 42 of 606

42. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 54-year-old lady presents with a one month history of deteriorating memory. She has otherwise been well and takes no regular medication.

Which one of the following is most typical of frontal lobe dysfunction?
- Visual field defects.
- Inability to perform serial 7s.
- Inability to draw a clock face.
- Inability to generate a list rapidly.
- Sensory inattention.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 43 of 606

43. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 68-year-old gentleman has three months history of memory loss, urinary incontinence and falls.

On examination he has mild memory loss and a broad-based, slow gait. Muscle tone is normal and both plantar reflexes are downgoing.

Which one of the following is the most reasonable diagnosis?
- Multi-infarct dementia.
- Alzheimer's disease.
- Normal-pressure hydrocephalus.
- Parkinson's disease.
- Frontal lobe dementia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 44 of 606

44. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 51-year-old lady presents with a left sided rest tremor and bradykinesia.

One year ago she noticed that she could not smell her food. She has not had any falls and her eye movements are normal. Her past medical history is unremarkable and she does not take any regular medication.

Which one of the following structures is most likely to be most affected?
- Red nucleus.
- Left cerebral neocortex.
- Left cerebellar hemisphere.
- Olfactory nerve.
- Substantia nigra.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 45 of 606

45. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Frontal lobe brain damage is associated with which one of the following?
- Auditory agnosia.
- Perseveration.
- Astereognosis.
- Focal epileptic fits.
- Dressing apraxia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 46 of 606

46. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 79-year-old gentleman with diabetes mellitus presented with sudden onset of wild flinging movements of the right arm which disappeared during sleep.

Which one of the following is the most likely cause of this presentation?
- Hypoglycaemia.
- Focal motor seizures.
- Ipsilateral caudate nucleus infarction.
- Contralateral subthalamic nucleus infarction.
- Ipsilateral cerebellar infarction.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 47 of 606

47. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 71-year-old lady presents with a severe headache, the worst she has ever had, affecting the back of her head and her neck.

On admission to the Emergency Department she is very agitated and requires opiate based pain relief for her headache. She has a history of hypertension for which she takes ramipril, amlodipine and indapamide. Her blood pressure is elevated at 180/100 mmHg and she has a tachycardia of 92 beats per minute.

She is severely photophobic and finds it impossible to comply with ophthalmoscopy. Neurological examination, as far as can be told, is normal.

Investigations Show:

Haemoglobin	115 g/L	(135-177)
Total Leucocyte Count	4.3 ×10⁹/L	(4-11)
Platelet Count	240 ×10⁹/L	(150-400)
Serum Sodium	141 mmol/L	(135-146)
Serum Potassium	4.1 mmol/L	(3.5-5)
Serum Creatinine	86 μmol/L	(79-118)
Computed Tomography (CT) Scan Head	Left parietal lobe haemorrhage

Which one of the following neurological findings would be mostly expected?

Acalculia.
Expressive dysphasia.
Left hemiplegia.
Dysphagia.
Contralateral homonymous superior quadrantanopia.

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 48 of 606

48. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A young lady who has suffered from cerebral venous sinus thrombosis associated with pregnancy is most likely to have been affected during which one of the following periods?
- In the 3rd trimester.
- In the 2nd trimester.
- In the postpartum period.
- In the 1st trimester.
- During birth.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 49 of 606

49. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 61-year-old gentleman presents with tremor of the hands which has been present for approximately four years.

He has a past medical history which includes anxiety and he receives salbutamol for asthma.

Examination revealed involution and an upper limb postural tremor.

Which one of the following is the most pertinent diagnosis?
- Parkinson’s disease.
- Salbutamol induced tremor.
- Anxiety disorder.
- Benign essential tremor.
- Multiple sclerosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 50 of 606

50. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 74-year-old gentleman presents with generalised bradykinesia.

Examination reveals a tremor of the hands.

Which one of the following frequencies of tremor could be suspected in Parkinson’s disease?
- 2 Hz.
- 8 Hz.
- 1 Hz.
- 5 Hz.
- 10 Hz.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 51 of 606

51. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 64-year-old gentleman has developed diplopia.

Which one of the following findings would suggest a third nerve palsy?
- Constricted pupil.
- Enophthalmos.
- Convergent strabismus.
- Increased lacrimation.
- Pupil unreactive to light.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 52 of 606

52. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 22-year-old old lady presents with complaint of three hours of a unilateral temporal headache increasing in severity and associated with nausea. The pain is of a pounding character and is exacerbated by light.

There are no abnormal signs on examination.

Which one of the following is the most plausible diagnosis?
- Acute subarachnoid haemorrhage.
- Cluster headache.
- Tension headaches.
- Intracranial tumour.
- Migraine.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 53 of 606

53. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 35-year-old lady presents with generalised weakness, diplopia and fatigue.

She had recently been diagnosed with rheumatoid arthritis.

On examination there is bilateral ptosis and weakness of abduction of both eyes and mild proximal weakness of the arms and legs but normal reflexes and sensation.

Which one of the following is the most reasonable diagnosis for this lady?
- Polymyositis.
- Myasthenia gravis.
- Mononeuritis multiplex.
- Multiple sclerosis.
- Guillain-Barré syndrome.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 54 of 606

54. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 23-year-old gentleman presents with new onset double vision.

On examination he experiences horizontal diplopia on looking to his far left. Covering his right eye only obscures the innermost image. Covering his left eye only obscures the outermost image. In the neutral position his left eye is deviated medially. He has no problem on looking to the far right.

His neurological examination is otherwise normal.

Which one of the following is most likely the problem?
- Left sided VIth nerve palsy.
- Left sided IVth nerve palsy.
- Right sided VIth nerve palsy.
- Concomitant left esotropia.
- Medial longitudinal fasciculus lesion.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 55 of 606

55. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 47-year-old lady has a five-month history of pain in her feet and lower legs. She was diagnosed as having diabetes at age of 21 and treated with insulin. She is a cannabis smoker and drinks 15 units of alcohol per week.

On examination she has impaired pain and temperature sensation in feet and lower legs, normal joint position and vibration sense. Her reflexes are normal.

Which one of the following is the most likely diagnosis?
- Alcoholic polyneuropathy.
- Diabetic polyneuropathy.
- Vitamin B12 deficiency.
- Chronic inflammatory demyelinating polyneuropathy (CIDP).
- Syringomyelia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 56 of 606

56. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 73-year-old gentleman presents with acute back pain followed by weakness of dorsiflexion of his right foot.

Where the associated sensory loss could be expected?
- Posterior calf.
- Perineum.
- Dorsum of foot.
- Anterior thigh.
- Sole of foot.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 57 of 606

57. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 68-year-old gentleman attends the memory clinic accompanied by his wife. She has noticed that he has become progressively more forgetful over the past few years and has begun to stroll at night. Most recently he became lost whilst shopping in the local village and had to be brought home by the police. This has caused his wife significant anguish.

On examination in the clinic he has easily demonstrable short-term memory loss, with relative preservation of memory for events from his 40s. He also has visuospatial dysfunction.

His blood pressure is 140/75 mmHg, pulse rate is 76 beats per minute and regular. There are no murmurs or bruits on auscultation.

Investigations Showed:

Haemoglobin	130 g/L	(135-177)
White Blood Cell Count	7.6 ×10⁹/L	(4-11)
Platelet Count	195 ×10⁹/L	(150-400)
Serum Sodium	139 mmol/L	(135-146)
Serum Potassium	4.4 mmol/L	(3.5-5)
Serum Creatinine	92 μmol/L	(79-118)
Computed Tomography (CT) Scan Head	Mild Cortical Atrophy

Which one of the following is the most congruent diagnosis?

Multi-infarct dementia.
Lewy body dementia.
Multiple system atrophy.
Pick's disease.
Alzheimer's dementia.

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 58 of 606

58. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Regarding central pontine myelinolysis, which one of the following statements is correct?
- The cause has been linked to over-rapid correction of hyponatraemic states.
- The pathological changes are confined to the pons.
- The condition is confined to malnourished alcoholic patients.
- Magnetic resonance imaging (MRI) scan shows diagnostic features in the majority of patients.
- Consciousness is preserved characteristically.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 59 of 606

59. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 75-year-old lady presented to her general physician having developed uncontrollable chucking movements of her left arm and leg in the last few days. She had been previously well prior to the event.

The movements were irregular involving the proximal limb muscles and did not follow a particular pattern. They occurred several times in a minute and had led to several falls. She had a past medical history of hypertension and ischaemic heart disease and took regular ramipril and aspirin. She was a smoker of 8 – 10 cigarettes per day and did not drink any alcohol. There was no family history of neurological disease.

On examination, she was alert and orientated, but had several episodes of flinging proximal movements of her left upper and lower limb that made examination difficult. Tone, power and reflexes all appeared normal and there were no obvious cranial nerve abnormalities. General examination revealed a blood pressure of 135/85 mmHg, pulse rate of 76 beats per minute and regular and heart sounds were normal.

Investigations Revealed:

Haemoglobin	155 g/L	(130 – 180)
Mean Corpuscular Volume (MCV)	88 fL	(80 – 96)
Total Leucocyte Count	10.3 ×10⁹/L	(4 – 11)
Platelet Count	295 ×10⁹/L	(150 – 400)
Serum Sodium	136 mmol/L	(137 – 144)
Serum Potassium	4.2 mmol/L	(3.5 – 4.9)
Serum Urea	3.4 mmol/L	(2.5 – 7.5)
Serum Creatinine	95 µmol/L	(60 – 110)
Fasting Plasma Glucose	8.7 mmol/L	(3 – 6)
Serum Cholesterol	6.1 mmol/L	(<5.2)

Which one of the following is the most likely diagnosis in this lady?

Senile chorea.
Functional disorder.
Infarction within the subthalamic nucleus.
Infarction within the substantia nigra.
Huntington disease.

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 60 of 606

60. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 20-year-old lady presented with a history of a sudden onset of a frontal headache and photophobia. She had neck stiffness and a temperature of 100.4°F.

Which one of the following findings would suggest a diagnosis of subarachnoid haemorrhage rather than bacterial meningitis?
- A history of opiate abuse.
- A history of diabetes mellitus.
- A blood neutrophil leucocytosis.
- A family history of polycystic renal disease.
- A fluctuating consciousness level.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 61 of 606

61. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following would be expected features of a right posterior cerebral artery occlusion?
- Decerebrate state.
- A left homonymous hemianopia.
- Pure aphasia (i.e. without alexia).
- Internuclear ophthalmoplegia.
- Wernicke's aphasia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 62 of 606

62. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 54-year-old lady is diagnosed with small cell lung cancer.

Despite a normal magnetic resonance imaging (MRI) scan of brain, she develops progressive truncal ataxia.

Which one of the following would be most beneficial in the diagnosis of her condition?
- Serum sodium.
- Lumbar puncture.
- Visual evoked potentials.
- Serum calcium.
- Anti-Purkinje cell antibody levels.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 63 of 606

63. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 70-year-old lady with Parkinson’s disease on donepezil and L-dopa presents with increasing agitation, inability to perform simple tasks, fluctuating consciousness, visual hallucinations, and memory loss over a period of eight months.

A magnetic resonance imaging (MRI) scan shows enlarged lateral ventricles as well as hypothalamic atrophy.

Dementia with Lewy bodies is diagnosed.

Which one of the following pathological changes would be expected in this condition?
- Micro-aneurysms and infarcts.
- Pick body formation.
- Alpha synuclein accumulation.
- Tau tangle formation.
- Beta amyloid plaque formation.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 64 of 606

64. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
An 18-year-old lady has been diagnosed with schizophrenia a month ago.

She was started on haloperidol. Three weeks later she was found confused and drowsy.

On examination she was pyrexial with a temperature of 105.0°F, rigid with blood pressure of 190/96 mmHg.

Which one of the following treatments should be initiated?
- Cefuroxime.
- Phenytoin.
- Aciclovir.
- Dantrolene.
- Diazepam.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 65 of 606

65. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 76-year-old gentleman presented with a relatively short history of headaches and episodic impairment of consciousness.

Which one of the following is the most likely cause of his presentation?
- Chronic subdural haematoma.
- Alzheimer-type dementia.
- Normal pressure hydrocephalus.
- Depressive stupor.
- Creutzfeldt-Jakob disease.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 66 of 606

66. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 46-year-old gentleman is admitted to the Emergency Department in a confused and agitated state. He has recently tried to stop drinking and according to his wife it is around 36 hours since he had his last drink.

On examination his blood pressure is elevated at 160/90 mmHg, pulse rate at 92 beats per minute, and he looks agitated. There are signs of chronic liver disease on physical examination. He is trying to pull the sheets over his head as he tells the examining doctor that he can see a large dog in the next bed.

Investigations Show:

Haemoglobin	112 g/L	(135-180)
Total Leucocyte Count	8.7 ×10⁹/L	(4-10)
Platelet Count	210 ×10⁹/L	(150-400)
Serum Sodium	140 mmol/L	(134-143)
Serum Potassium	4.1 mmol/L	(3.5-5)
Serum Creatinine	108 μmol/L	(60-120)
Serum Glucose	4.8 mmol/L	(3.6-5.8)
Serum Alanine Aminotransferase (ALT)	185 IU/L	(5-60)

Which one of the following is the most plausible diagnosis?

Schizophrenia.
Alcoholic hallucinosis.
Wernicke's encephalopathy.
Hypomania.
Delirium tremens.

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 67 of 606

67. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 31-year-old gentleman is brought to the Emergency Department with a history of transient ischaemic attack affecting his left side and speech. He was previously well and fit.

He had returned to the United Kingdom from a holiday in Australia three days before the incident.

On examination there was nothing abnormal to find. An electrocardiogram (ECG), chest x-ray, computed tomography (CT) of brain, and routine haematology and biochemistry were all normal.

Which one of the following is the most proper underlying abnormality?
- Subarachnoid haemorrhage.
- Carotid artery stenosis.
- Embolus from paroxysmal atrial fibrillation.
- Atrial myxoma.
- Patent foramen ovale.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 68 of 606

68. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 62-year-old lady presents with sudden onset weakness of her legs associated with urinary retention. Seven years ago she was diagnosed with sigmoid colonic carcinoma which was surgically resected.

Examination revealed a flaccid paraparesis of the legs with absent tendon reflexes and plantar responses. Pinprick and temperature sensations were absent to T12 level, but there was a relative sparing of light touch and joint position sensation.

Which one of the following is the most reasonable diagnosis?
- Anterior spinal artery occlusion.
- Transverse myelitis.
- Spinal cord compression due to vertebral metastasis.
- Intramedullary spinal cord metastasis.
- T11-T12 central disc prolapse
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 69 of 606

69. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 75-year-old gentleman is admitted with acute confusion and is agitated and aggressive to healthcare staffs.

His relatives who accompany him state that he had been entirely self-caring, does not drink alcohol and takes no regular medication. He was diagnosed with a urinary tract infection and commenced on antibiotics but remained agitated and distressed.

Which one of the following treatments is the most appropriate one for his agitation?
- Temazepam.
- Haloperidol.
- Diazepam.
- Chlorpromazine.
- Trazodone.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 70 of 606

70. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
The incidence of Down syndrome in children born to women aged less than 30 years is approximately which one of the following?
- 1:15000.
- 1:10000.
- 3.513888889
- 0.736111111
- 0.388888889
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 71 of 606

71. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 71-year-old gentleman presents with a three month history of episodic loss of vision in his left eye.

His electrocardiogram was normal and carotid ultrasound revealed a 49% stenosis of the left internal carotid artery, as assessed by the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria.

Initially, which one of the following is the most appropriate treatment for this gentleman?
- Clopidogrel.
- Carotid endarterectomy.
- Aspirin.
- Dipyridamole.
- Warfarin.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 72 of 606

72. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 42-year-old lady with a central scotoma found in her left eye during a routine eye test is referred by her ophthalmologist to the Neurology Clinic for evaluation.

On examination of her cranial nerves she is poorly compliant and she keeps laughing. She says that she is unable to smell anything and that she can no longer read as well as she would like. On fundoscopy, her right fundus is hyperaemic and oedematous and clear views of her left fundus could not be obtained.

Which one of the following is the most likely diagnosis?
- Foster Kennedy's syndrome.
- Leigh syndrome.
- Drug abuse.
- Leber's hereditary optic neuropathy.
- Kallmann’s syndrome.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 73 of 606

73. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 72-year-old lady presents to the Emergency Department with sudden loss of vision in her left eye, associated with a relative afferent pupillary defect.

She has poorly controlled systemic hypertension and raised cholesterol.

Which one of the following is the most likely aetiology of her presentation?
- Macular degeneration.
- Chronic open angle glaucoma.
- Cataract.
- Retinitis pigmentosa.
- Retinal vascular occlusion.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 74 of 606

74. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A broad-based ataxic gait characteristically occurs with which one of the following?
- Phenytoin toxicity.
- Cerebellar vermis lesion.
- Basal ganglia lesion.
- Right-sided cerebral infarction.
- Proximal myopathy.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 75 of 606

75. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 69-year-old lady is diagnosed with a Lewy body dementia.

Which one of the following drugs would be contraindicated for this lady?
- Chlormethiazole.
- Haloperidol.
- Donepezil.
- Selegiline.
- L-Dopa.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 76 of 606

76. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 28-year-old lady presents with weight gain, some hair loss and a tremor seven months after commencing single drug treatment for epilepsy.

Which one of the following drugs is most likely to be responsible for her presentation?
- Phenytoin.
- Lamotrigine.
- Carbamazepine.
- Sodium valproate.
- Topiramate.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 77 of 606

77. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 74-year-old gentleman has a four-month history of progressive numbness and unsteadiness of his gait. He has a history of hypertension which is controlled with indapamide and lisinopril and diet controlled diabetes but is otherwise well.

On examination his blood pressure is 130/80 mmHg, pulse rate is 74 beats per minute and regular, heart sounds are normal, abdomen is soft and non-tender, and his body mass index (BMI) is 24 kg/m². There is a mild spastic paraparesis, with brisk knee reflexes, ankle reflexes are present with reinforcement, extensor plantars, sensory loss in the legs with a sensory level at T10, impaired joint position sense in the toes, and loss of vibration sense below the iliac crests.

Investigations Show:

Haemoglobin

124 g/L

(120-160)

Mean Corpuscular Volume (MCV)

93 fL

(80-96)

Which one of the following is the most plausible diagnosis?
- Anterior spinal artery occlusion.
- Tabes dorsalis.
- Dorsal meningioma.
- Subacute combined degeneration of the cord.
- Multiple sclerosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 78 of 606

78. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 45-year-old gentleman, with an alleged history of a road traffic accident, is seen in the Emergency Department. His memory of events is poor but he thinks he banged his head. His main complaint now is of extreme pain in his left eye.

On examination he has reduced visual acuity (counting fingers only), proptosis and complete ophthalmoplegia of his left eye. It is noticed that the eye is injected, chemosis is present and on closer inspection the eye appears to be pulsating.

Which one of the following is the most reasonable diagnosis?
- Blow-out fracture.
- Acute glaucoma.
- Retinal haemorrhage.
- Caroticocavernous fistula.
- Cavernous sinus thrombosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 79 of 606

79. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
An 81-year-old lady is brought to the Emergency Department with an ischaemic stroke and a right hemiparesis.

How would the right hemiparesis with which she presents be classified according to the WHO international classification of functioning, disability and health (ICF)?
- Participation restriction.
- Activity limitation.
- Pathology.
- Right total anterior circulation infarct.
- Impairment of body function.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 80 of 606

80. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 24-year-old gentleman presents to the Emergency Department with a right sided postural tremor, a shuffling gait, dysarthric speech, ataxia and difficulty swallowing. He reports a family history of liver problems and tremor.

Which one of the following is the most pertinent test to make a diagnosis?
- Serum caeruloplasmin.
- Computed tomography (CT) scan of head.
- Serum copper.
- Genetic testing.
- Urine copper.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 81 of 606

81. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 36-year-old lady presents to the Outpatient Clinic with a week history of left arm weakness. Initially the problem began with severe pain in the neck which radiated into the left shoulder, which was followed by weakness.

Examination revealed winging of the left scapula with weakness of left shoulder abduction and elbow extension. There was some sensory loss over the lateral aspect of the left shoulder and left triceps reflex was absent.

Which one of the following is the most plausible diagnosis?
- C7 entrapment radiculopathy.
- Central C5-C6 disc prolapse.
- Traction of lateral cord of brachial plexus.
- Neuralgic amyotrophy.
- Suprascapular nerve entrapment.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 82 of 606

82. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 72-year-old lady is admitted with an acute stroke.

Examination revealed a right Horner’s syndrome, loss of corneal reflex on the right together with loss of pinprick sensation on the right side of the face.

Her right gag reflex was also decreased. She had right limb ataxia with left hemi-sensory loss of pain and temperature sensation.

Which one of the following arterial territories has been affected?
- Basilar.
- Right posterior inferior cerebellar.
- Left posterior communicating.
- Right superior cerebellar.
- Left posterior inferior cerebellar.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 83 of 606

83. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 31-year-old lady presents to the Neurology Clinic with a three year history of intermittent tingling sensation involving her right side.

It starts in her fingers and spreads in 10-15 seconds to affect the whole arm and leg on the same side. The attacks only last for about one minute.

Which one of the following is the most pertinent diagnosis?
- Migraine with aura.
- Multiple sclerosis.
- Hyperventilation.
- Transient ischaemic attacks.
- Somatosensory seizures.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 84 of 606

84. Question

0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

A 61-year-old gentleman presented to his general physician with a four-month history of progressive distal sensory loss and weakness of both legs and arms. The weakness and numbness had extended to the elbows and knees.

On examination, cranial nerves and fundoscopy were normal. Examination of the upper limb revealed bilaterally reduced tone and 3/5 power.

Lower limb examination revealed some mild weakness of hip flexion and extension with marked weakness of dorsiflexion and plantarflexion. Both knee and ankle jerks were absent and both plantar responses were diminished. There was absent sensation to all modalities affecting both feet extending to the knees.

Lumbar Puncture Showed:

Opening Pressure	13 cm H2O	(5-18)
CSF Protein	0.72 g/L	(0.15-0.45)
CSF White Cell Count	9 cells per ml	(<5 cells)
CSF White Cell Differential Count	88% lymphocytes	–
CSF Red Cell Count	3 cells per ml	(<5 cells)

Nerve conduction studies showed multifocal motor and sensory conduction block with prolonged distal latencies.

Which one of the following is the most likely diagnosis in this gentleman?

Guillain-Barré syndrome.
Cervical spondylosis.
Chronic inflammatory demyelinating neuropathy (CIDP).
Multifocal motor neuropathy.
Hereditary motor and sensory neuropathy (HMSN).

Correct

Incorrect

Hint

The other options are less likely for the following reasons:

A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.

Question 85 of 606

85. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 61-year-old gentleman is admitted with progressive weakness for one month following an inconsequential flu-like illness.

Which one of the following would make Guillain-Barré syndrome an unlikely diagnosis?
- Elevated protein on cerebrospinal fluid (CSF) examination.
- Marked muscle wasting.
- Autonomic dysfunction.
- Sensory level below T1.
- Hyporeflexia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 86 of 606

86. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 42-year-old gentleman presents with complaints of headaches and low libido.

He is found to be hypopituitary.

The computed tomography (CT) scan shows a pituitary tumour with suprasellar extension.

Which one of the following structures is likely to be compressed?
- Optic chiasm.
- Oculomotor nerve.
- Abducens nerve.
- Third ventricle.
- Hypothalamus.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 87 of 606

87. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 26-year-old gentleman presents to the Emergency Department with history of recurrent episodes of loss of consciousness.

Over the last three years he has had blackouts which last approximately half a minute. They typically occur when he is standing. These have occurred more frequently over the last one week.

The latest episode was witnessed by one of his colleagues who noted that he collapsed without any abnormal movements. On coming round he was rather drowsy initially but generally fine and recovered relatively quickly.

Which one of the following is the most proper diagnosis?
- Atonic seizures.
- Vasovagal syncope.
- Addison's disease.
- Cardiac syncope.
- Complex partial seizures.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 88 of 606

88. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 27-year-old gentleman has recovered from the immediate effects of a head injury sustained in a motor cycle accident four months previously.

Which one of the following is the most likely delayed consequence of severe traumatic brain injury?
- Outbursts of aggressive behaviour.
- Episodic hypersomnia.
- Persistent anxiety.
- Pathological jealousy.
- Multiple obsessional symptoms.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 89 of 606

89. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 28-year-old lady comes to the clinic concerned about her 3-year-old daughter.

She has noticed that she typically laughs inappropriately for no particular reason. Shortly after an event she appears to be twiddling. These events last only for few minutes and in between the events she acts normally. Gelastic seizure is suspected by the physician.

Where from do these gelastic seizures typically arise?
- Brainstem.
- Frontal lobes.
- Temporal lobe.
- Hypothalamus.
- Pineal gland.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 90 of 606

90. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 63-year-old lady presents with central back pain which radiates down to her right foot. There is paraesthesia over the lateral aspect of the right foot, impaired ankle jerk and weakness of plantarflexion. Her left leg has no abnormality.

Which one of the following is the most likely cause of her presentation?
- L3-L4 disc prolapse.
- Cervical disc prolapse.
- Cauda equina syndrome.
- L4-L5 disc prolapse.
- L5-S1 disc prolapse.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 91 of 606

91. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 74-year-old lady presented to the Emergency Department with acute left-sided weakness.

Examination revealed minimal left facial weakness, impaired elevation of the left shoulder, with relatively preserved left hand strength. There was global weakness in the left leg which appeared to be maximal in the foot.

Which one of the following arteries is most likely have been affected?
- Anterior cerebral artery.
- Lenticulostriate artery.
- Posterior communicating artery.
- Posterior cerebral artery.
- Middle cerebral artery.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 92 of 606

92. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 41-year-old lady suffers from migraine headaches. She smokes 15 cigarettes daily.

She has found that paracetamol 1 gm was not always effective in relieving her pain.

Which one of the following factors is the most likely to account for this problem?
- First pass metabolism.
- Delayed gastric emptying.
- Altered volume of distribution.
- Hepatic enzyme induction.
- Reduced gut blood flow.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 93 of 606

93. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 46-year-old lady presented with a three week history of recurrent severe left-sided peri-orbital headache, frequently nocturnal and occurring at least once daily, usually lasting for an hour.

She had noticed lacrimation from the left eye and blockage of the left nostril during the headache. At the time of the examination she had no headache and there were no abnormal physical signs.

Which one of the following is the probable diagnosis?
- Left maxillary sinusitis.
- Intracranial aneurysm.
- Cluster headache.
- Trigeminal neuralgia.
- Orbital pseudotumour.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 94 of 606

94. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 31-year-old woman presents to the Emergency department following a witnessed first ever seizure. She is drowsy and confused postictally.

A computed tomography (CT) scan of brain shows petechial haemorrhages in the right hemisphere. A magnetic resonance imaging (MRI) shows cerebral venous sinus thrombosis.

Which one of the following would be the best initial treatment?
- Antibiotics.
- Aspirin.
- Vitamin K.
- Heparin.
- Supportive management.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 95 of 606

95. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 35-year-old gentleman presents to the Emergency Department after waking up with difficulty in vision. He has no past medical history of note and is currently on no medication.

On examination he has decreased visual acuity of the right eye and red desaturation. He is concerned that he has multiple sclerosis.

He is explained that this is not by definition of multiple sclerosis.

What is his chance of developing multiple sclerosis?
- 25%.
- 33%.
- 100%.
- 75%.
- 50%.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 96 of 606

96. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 28-year-old lady comes to the clinic because she is concerned that her right pupil is abnormally large. Her colleagues noticed it and suggested she should see the doctor.

She has no past medical history of note, apart from an episode of shingles a few months earlier, and takes the oral contraceptive pill as her only medication. On further questioning she admits to unprotected sexual intercourse on three to four occasions over the past four to five years.

On examination her right pupil is clearly larger than the left. It hardly reacts to light at all, but does accommodate to near vision. It is noticed that re-dilatation is very slow however. Her blood pressure is normal at 130/75 mmHg, and general physical examination is unremarkable.

Which one of the following is the best way to confirm the diagnosis?
- Reaction to weak miotic eye drops.
- Lumbar puncture.
- Chest x-ray.
- Magnetic resonance imaging (MRI) scan of brain.
- Syphilis serology.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 97 of 606

97. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 59-year-old gentleman was brought to the Emergency Department with slurring of speech.

Examination reveals bilateral partial ptosis and frontal balding, and difficulty releasing his grip after shaking hands.

Which one of the following is the most presumed diagnosis?
- Myasthenia gravis.
- Myotonia dystrophica.
- Duchenne muscular dystrophy.
- Myotonia congenita.
- Eaton-Lambert syndrome.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 98 of 606

98. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 28-year-old gentleman with epilepsy presents to the Emergency Department with visual problems.

Examination reveals a constriction of visual fields to confrontation.

Which one of the following is most probably responsible for his visual deterioration?
- Phenytoin.
- Gabapentin.
- Vigabatrin.
- Sodium valproate.
- Lamotrigine.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 99 of 606

99. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 21-year-old lady presents with a history of four episodes of severe headaches over the past eight months. She describes the headaches as dreadful, left-sided and lasting for ten hours and associated with nausea and photophobia. Each episode is preceded by spots before her eyes.

Which one of the following is the most appropriate initial treatment for this lady?
- Diclofenac at the onset of the next attack.
- Ergotamine suppository at the onset of the next attack.
- Prophylaxis with propranolol.
- Paracetamol plus metoclopramide at the onset of the next attack.
- Sumatriptan at the onset of the next attack.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 100 of 606

100. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 27-year-old gentleman presents with a four-day history of progressive weakness and numbness of his legs, urinary retention and back pain for three weeks following an upper respiratory infection.

On examination there is spastic paraparesis, sensory level up to T5, extensor plantars.

Examination of cranial nerves and upper limbs is normal. Magnetic resonance imaging (MRI) scan of the spine is normal.

Which one of the following is the most likely diagnosis?
- Anterior spinal artery occlusion.
- Thoracic disc prolapse.
- Guillain-Barré syndrome.
- Post-infectious transverse myelitis.
- Multiple sclerosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 101 of 606

101. Question
1 point(s)

Category: Cardiology Module June 2022 MRCP Part-1
Among the following option find out the appropriate state for contraindication of Thrombolysis?
- Recurrent attack of bronchial asthma.
- Past history of Haemorrhagic Stroke.
- Long standing Diabetic Retinopathy.
- Known case of Atrial Fibrillation (AF).
- Elderly population over 75 Years.
Correct

Incorrect

Hint

The common absolute contraindications to thrombolysis include:_x000D_
• Recent history of stroke or surgery (within 3 months)_x000D_
• Previous history of haemorrhagic stroke_x000D_
• Prolonged cardiopulmonary resuscitation (CPR) (more than half an hour)._x000D_
• Heavy ongoing haemorrhagic manifestations including torrential GI bleeding_x000D_
• Uncontrolled severe hypertension_x000D_
• Space occupying lesion of brain, cerebral neoplasm._x000D_
People over aged 75 years may be benefited from thrombolysis in AMI._x000D_
Progressive diabetic retinopathy may be a relative contraindication of thrombolysis.
Question 102 of 606

102. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 48-year-old lady attends the clinic with pityriasis versicolor.

Which one of the following is the most appropriate first line management?
- Psoralen with ultraviolet light-A (PUVA) therapy.
- Topical selenium sulphide.
- Oral terbinafine.
- Methotrexate.
- Phototherapy with ultraviolet light (UVB).
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 103 of 606

103. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following is a feature of hereditary haemorrhagic telangiectasia?
- A good response to oestrogen therapy.
- Tendency of lesions to become less obvious with age.
- Cerebral arteriovenous malformations.
- Telangiectasia of the mucous membranes, but not the skin.
- Gastrointestinal (GI) haemorrhage is the usual presenting feature.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 104 of 606

104. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 48-year-old lady presents to the clinic four weeks after she returns from a backpacking holiday in Sweden with a shallow, painless ulcer of the nose.

Which one of the following is the most plausible diagnosis?
- Leishmaniasis.
- Trichomoniasis.
- Squamous cell carcinoma (SCC).
- Fusobacterium ulcerans.
- Trypanosomiasis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 105 of 606

105. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 69-year-old gentleman presented to the Outpatient Department with an ulcer over the right ankle, which had developed over the previous seven months. He had a history of left deep vein thrombosis (DVT) four years earlier.

On examination he had a superficial slough-based ulcer, 5.0 cm in diameter, over the medial malleolus with no evidence of cellulitis.

Which one of the following investigations is required before application of compression bandaging?
- Venous duplex ultrasound scan.
- Bacteriological swab of the ulcer.
- Bilateral lower limb arteriogram.
- Ankle-brachial pressure index.
- Left leg venogram.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 106 of 606

106. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 15-year-old girl is diagnosed with scabies.

Which one of the following statements regarding scabies is correct?
- Is best treated by salicylate emulsion.
- It can be spread by a droplet infection.
- Typically affects the face.
- It is caused by Staphylococcus aureus.
- It causes itchiness in the skin even where there is no obvious lesion to notice.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 107 of 606

107. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 7-year-old girl with crops of asymptomatic rash over the trunk for three months was admitted to the paediatric ward.

Examination revealed skin coloured to pearly white and hemispherical to umbilicated papular lesions. Each one is approximately 3.0 mm in diameter and there are approximately 18 of these lesions present.

Which one of the following is the most anticipated diagnosis?
- Molluscum contagiosum.
- Cutaneous cryptococcosis.
- Warts.
- Herpes simplex.
- Folliculitis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 108 of 606

108. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 23-year-old primigravida at 11 weeks 3 days of gestation attends the antenatal clinic and is noted to have scattered, small, raised lesions on her trunk and axillary freckles.

She did not know whether any of her family members having these lesions or not.

Which one of the following is the most likely mode of inheritance of this condition?
- X-linked dominant.
- Trinucleotide repeating.
- Autosomal recessive.
- Autosomal dominant.
- X-linked recessive.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 109 of 606

109. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 30-year-old gentleman presents to the clinic with symmetrical, depigmented areas on his arms and legs. He is otherwise fit and quite well.

Which one of the following diseases is most likely to be associated with his skin disease?
- Scleroderma.
- Diabetes mellitus.
- Hyperparathyroidism.
- Systemic lupus erythematosus (SLE).
- Pernicious anaemia.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 110 of 606

110. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 17-year-old girl with scaly patches on her scalp is brought to the clinic by her parents for a review. Examination reveals well-circumscribed, circular areas of hair loss, 1 – 5 cm in diameter with scaling and raised margins. There is no scarring.

Which one of the following is the most likely cause for this presentation?
- Morphea.
- Tinea capitis.
- Systemic lupus erythematosus (SLE).
- Lichen planus.
- Discoid lupus erythematosus.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 111 of 606

111. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
Which one of the following assertions regarding cutaneous anthrax is correct?
- Causes a black eschar which overlies pus.
- Lesions are usually painful and tender.
- Lesions are associated with marked oedema.
- Mortality is approximately 20% despite antibiotic therapy.
- Is very likely to occur in subjects exposed to anthrax spores.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 112 of 606

112. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1
A 56-year-old gentleman underwent a renal transplant seven years ago and is on ciclosporin since then. He now presents with a small, hard lesion on the side of his head. It has a brown irregular border with a central hard area.

Which one of the following is the most likely diagnosis?
- Seborrhoeic keratosis.
- Basal cell carcinoma (BCC).
- Malignant melanoma.
- Squamous cell carcinoma (SCC).
- Actinic keratosis.
Correct

Incorrect
Hint

The most plausible diagnosis for this lady presenting with headache, bilateral blurring of the optic discs, and pupil-sparing third nerve palsy on the left is D. Sagittal sinus thrombosis. This is because sagittal sinus thrombosis is a rare condition that occurs when a blood clot forms in the sagittal sinus, which is a large vein that drains blood from the brain. This can cause increased pressure in the brain, leading to symptoms such as headache, blurred vision, and cranial nerve palsies. Sagittal sinus thrombosis is more common in women, especially during pregnancy and the postpartum period, due to hormonal changes and hypercoagulability.

The other options are less likely for the following reasons:
- A. Herpes simplex virus (HSV) encephalitis: Herpes simplex virus (HSV) encephalitis is a rare but serious infection of the brain caused by the herpes simplex virus. It can cause headache, fever, confusion, seizures, and focal neurological deficits. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not focal brain inflammation.
- B. Brainstem cerebrovascular accident (CVA): A brainstem cerebrovascular accident (CVA) is a stroke that affects the brainstem, which is the part of the brain that controls vital functions such as breathing, heart rate, and blood pressure. It can cause headache, dizziness, nausea, vomiting, and cranial nerve palsies. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not brainstem ischaemia. Moreover, a brainstem cerebrovascular accident (CVA) would not spare the pupil, as the third nerve fibers that control the pupil are located in the brainstem.
- C. Meningococcal meningitis: Meningococcal meningitis is a severe infection of the meninges, which are the membranes that cover the brain and spinal cord, caused by the bacterium Neisseria meningitidis. It can cause headache, fever, neck stiffness, photophobia, and rash. It can also cause cranial nerve palsies, especially of the sixth and seventh nerves. However, it is unlikely to cause bilateral blurring of the optic discs or pupil-sparing third nerve palsy, as these are signs of increased intracranial pressure, not meningeal inflammation.
- E. Sphenoidal wing meningioma: A sphenoidal wing meningioma is a benign tumour that arises from the meninges near the sphenoid bone, which is a bone at the base of the skull. It can cause headache, visual loss, and cranial nerve palsies, especially of the third, fourth, and sixth nerves. However, it is unlikely to cause bilateral blurring of the optic discs, as this is a sign of increased intracranial pressure, not a focal mass lesion. Moreover, a sphenoidal wing meningioma would not spare the pupil, as the third nerve fibers that control the pupil are located close to the tumour site.
Question 113 of 606

113. Question
0 point(s)

Category: Neurology Module July 2022 MRCP Part-1

Neurology Module July 2022 MRCP Part-1