- Email: [email protected]
CPD
SELF-ASSESSMENT
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 A previously well 22-year-old man with no relevant family history had experienced a toniceclonic seizure with loss of consciousness for the first time witnessed by his girlfriend. No abnormalities were found on general and neurological examination. Full haematological and biochemical screen and ECG were normal. He was not on any medication, smoked 10 cigarettes/day and drank about 25 units of alcohol weekly. In advising him about his condition it is UNTRUE that: A
the risk of having a second seizure would be considerably reduced by starting an anti-epileptic drug (AED)
B
a brain tumour is responsible for about 6% of incident cases of epilepsy
C
no cause can be identified in the majority of people developing seizures
D
the increased standardized mortality ratio (SMR) for all people with epilepsy is largely attributable to the underlying cause
E
there is a greater risk of sudden unexplained death in epilepsy (SUDEP) if it is associated with learning difficulties
absence of abnormalities on EEG taken between attacks excludes the diagnosis
B
presence of abnormalities on EEG taken between attacks confirms the diagnosis
C
a trial of an anti-epileptic drug (AED) is an effective way of excluding true epilepsy when psychogenic non-epileptic seizures (PNES) is suspected
D
psychogenic non-epileptic seizures (PNES) can occur in people with true epilepsy
E
an isolated concussive convulsion associated with head injury, with normal neuroimaging, following a syncopal attack will usually result in a driving ban
dysphasia AND a lacunar stroke of the posterior limb of the internal capsule
B
homonymous hemianopia AND ophthalmic artery embolism
MEDICINE 40:9
D
visual inattention AND posterior cerebral artery infarction
F
vertigo AND anterior circulation stroke
A
MRI is superior to CT in demonstrating a posterior circulation infarction in the posterior fossa
B
MRI is superior to CT in detecting haemorrhage in the hyper-acute phase
C
the CT appearances 10 days after an acute haemorrhage are of hypodensity
D
Doppler ultrasound (U/S) is the commonest modality used to image the carotid arteries when neurovascular symptoms occur in the anterior circulation
E
MR venography and CT venography have the same sensitivity in the diagnosis of cerebral venous thrombosis
5 A previously well 82-year-old retired schoolmaster living alone in a remote cottage was admitted in the evening. He had apparently woken 12 h ago with right-sided weakness and dysphasia and had had difficulty contacting his family who lived some distance away. He had well-controlled type 2 diabetes and hypertension diagnosed at GP screening 7 years ago and was on treatment with glicazide and ramipril. CT brain scan confirmed ischaemic infarction in the territory of the left middle cerebral artery. BP 160/90. Regarding his management it is TRUE that:
3 Regarding the neurological consequences of a stroke the following clinical feature is CORRECTLY paired with the relevant area of the brain and its blood supply: A
lower motor neurone (LMN) facial weakness AND posterior circulation stroke
4 Regarding neuroimaging in a patient with an acute stroke it is UNTRUE that:
2 When differentiating true epilepsy from other conditions which may resemble it, it is CORRECT that: A
C
A
he should be positioned sitting up in bed to augment cerebral blood flow
B
thrombolysis is contraindicated by his age
C
wearing compression stockings has been shown to significantly reduce the risk of developing deep vein thrombosis (DVT) in this setting
D
his ABCD2 score indicates that he is at low risk of recurrence of stroke
E
he should immediately be started on aspirin 160 mg daily continued for at least the next 2 weeks
For the answers and for more questions, go to:
www.medicinecpd.co.uk 522
Self-assessment/CPD This CPD section was prepared by Eric Beck
Questions
We hope you enjoy the CPD section. Let us know your views by email to: [email protected]
FRCP FRCP(Ed) FRCP(Gl)
Select the ONE single best answer from the five alternatives:
1 A previously well 22-year-old man with no relevant family history had experienced a toniceclonic seizure with loss of consciousness for the first time witnessed by his girlfriend. No abnormalities were found on general and neurological examination. Full haematological and biochemical screen and ECG were normal. He was not on any medication, smoked 10 cigarettes/day and drank about 25 units of alcohol weekly. In advising him about his condition it is UNTRUE that: A
the risk of having a second seizure would be considerably reduced by starting an anti-epileptic drug (AED)
B
a brain tumour is responsible for about 6% of incident cases of epilepsy
C
no cause can be identified in the majority of people developing seizures
D
the increased standardized mortality ratio (SMR) for all people with epilepsy is largely attributable to the underlying cause
E
there is a greater risk of sudden unexplained death in epilepsy (SUDEP) if it is associated with learning difficulties
absence of abnormalities on EEG taken between attacks excludes the diagnosis
B
presence of abnormalities on EEG taken between attacks confirms the diagnosis
C
a trial of an anti-epileptic drug (AED) is an effective way of excluding true epilepsy when psychogenic non-epileptic seizures (PNES) is suspected
D
psychogenic non-epileptic seizures (PNES) can occur in people with true epilepsy
E
an isolated concussive convulsion associated with head injury, with normal neuroimaging, following a syncopal attack will usually result in a driving ban
dysphasia AND a lacunar stroke of the posterior limb of the internal capsule
B
homonymous hemianopia AND ophthalmic artery embolism
MEDICINE 40:9
D
visual inattention AND posterior cerebral artery infarction
F
vertigo AND anterior circulation stroke
A
MRI is superior to CT in demonstrating a posterior circulation infarction in the posterior fossa
B
MRI is superior to CT in detecting haemorrhage in the hyper-acute phase
C
the CT appearances 10 days after an acute haemorrhage are of hypodensity
D
Doppler ultrasound (U/S) is the commonest modality used to image the carotid arteries when neurovascular symptoms occur in the anterior circulation
E
MR venography and CT venography have the same sensitivity in the diagnosis of cerebral venous thrombosis
5 A previously well 82-year-old retired schoolmaster living alone in a remote cottage was admitted in the evening. He had apparently woken 12 h ago with right-sided weakness and dysphasia and had had difficulty contacting his family who lived some distance away. He had well-controlled type 2 diabetes and hypertension diagnosed at GP screening 7 years ago and was on treatment with glicazide and ramipril. CT brain scan confirmed ischaemic infarction in the territory of the left middle cerebral artery. BP 160/90. Regarding his management it is TRUE that:
3 Regarding the neurological consequences of a stroke the following clinical feature is CORRECTLY paired with the relevant area of the brain and its blood supply: A
lower motor neurone (LMN) facial weakness AND posterior circulation stroke
4 Regarding neuroimaging in a patient with an acute stroke it is UNTRUE that:
2 When differentiating true epilepsy from other conditions which may resemble it, it is CORRECT that: A
C
A
he should be positioned sitting up in bed to augment cerebral blood flow
B
thrombolysis is contraindicated by his age
C
wearing compression stockings has been shown to significantly reduce the risk of developing deep vein thrombosis (DVT) in this setting
D
his ABCD2 score indicates that he is at low risk of recurrence of stroke
E
he should immediately be started on aspirin 160 mg daily continued for at least the next 2 weeks
For the answers and for more questions, go to:
www.medicinecpd.co.uk 522