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LO 1 COMPAREAND CONTRAST CONSCIOUSAND UNCONSCIOUS STA TES PRESENTED BY CHRISTOPHERWATANABE 1. 32-year-old male has been ice skating but has slipped on the ice and hit his head.He is unconscious in the initial assessment.His arm is abnormally flexed,and legs are internally rotated.The patient occasionally makes sounds like “arrrhh” and“mhhh” and does not open eye even when pinching their shoulder.Due to his low GCS he is undergoing intubated and ventilated by the anaesthetic team.Given the information above,what is his GCS score? A Five B Six C Seven D Eight Nine E 1. 32-year-old male has been ice skating but has slipped on the ice and hit his head.He is unconscious in the initial assessment.His arm is abnormally flexed,and legs are internally rotated.The patient occasionally makes sounds like “arrrhh” and“mhhh” and does not open eye even when pinching their shoulder.Due to his low GCS he is undergoing intubated and ventilated by the anaesthetic team.Given the information above,what is his GCS score? A Five B Six C Seven D Eight Nine E 2. Neurosurgical SHO recieves a phone call from ED for neurosurgical review of 25 year old female patient who had RTC (road traffic collision) with obvious laceration and trauma to head,face,neck.He has fracture of the skull, mandible.From initial investigation it is shown that his pao2 = 6.2kpa,paco2 = 7kpa and his GCS = 8.From the CT images,it is clear that she has subdural hematomas.She begins to undergo seizure after taking CT image. What is the best initial management for this patient? A Craniotomy B Intubation C IV Infusion of 0.25 - 2 g/kg Mannitol D PR 10-20mg Lorazepam 500ml bolus of 0.9% NaCl E 2. Neurosurgical SHO recieves a phone call from ED for neurosurgical review of 25 year old female patient who had RTC (road traffic collision) with obvious laceration and trauma to head,face,neck.He has fracture of the skull, mandible.From initial investigation it is shown that his pao2 = 6.2kpa,paco2 = 7kpa and his GCS = 8.From the CT images,it is clear that she has subdural hematomas.She begins to undergo seizure after taking CT image. What is the best initial management for this patient? A Craniotomy B Intubation C IV Infusion of 0.25 - 2 g/kg Mannitol D PR 10-20mg Lorazepam 500ml bolus of 0.9% NaCl E 3. There is 56 year old male has been transferred to ED.They called the ambulance after he suddenly collapsed and fell after sudden weakness in the arm & leg.He has no consciousness and his GCS=3.From taking collateral history from his wife,it is found that he has PMH of hypertension and atrial fibrillation.He was initially taking apixaban but he stopped taking after feeling tried and weak.From CT angiography,he is found to have clot in the basilar artery. Which structure has been damaged as a result of his ischaemic stroke? A Internal Capsule B Frontal lobe C Occipital lobe D Vestibular nuclei Reticular Activating System (RAS) E 3. There is 56 year old male has been transferred to ED.They called the ambulance after he suddenly collapsed and fell after sudden weakness in the arm & leg.He has no consciousness and his GCS=3.From taking collateral history from his wife,it is found that he has PMH of hypertension and atrial fibrillation.He was initially taking apixaban but he stopped taking after feeling tried and weak.From CT angiography,he is found to have clot in the basilar artery. Which structure has been damaged as a result of his ischaemic stroke? A Internal Capsule B Frontal lobe C Occipital lobe D Vestibular nuclei Reticular Activating System (RAS) E 4. 6 year old female patient is found to have meningitis caused by HSV-2.She is also receiving chemotherapy from leukaemia.Her GCS is 7/15 and written as E2V3 M2.Her motor response is affected by increased ICP in meningitis.What is the motor response seen in patient who scored M2? A Patient swerves the arm when pinching the arm B Patient has decerebrate posture C Patient has decorticate posture D Patient rolls away when pinching them Patient doesn’t have any movement E 4. 6 year old female patient is found to have meningitis caused by HSV-2.She is also receiving chemotherapy from leukaemia.Her GCS is 7/15 and written as E2V3 M2.Her motor response is affected by increased ICP in meningitis.What is the motor response seen in patient who scored M2? A Patient swerves the arm when pinching the arm B Patient has decerebrate posture C Patient has decorticate posture D Patient rolls away when pinching them Patient doesn’t have any movement E 5. A 28-year-old man is brought intoA&E with a reduced level of consciousness.His friends believe he has ingested large quantities of an unknown substance.He says words like“difficult”,“painful”,“doctor”.But she is not able to make full sentence.What is his verbal response score? A Five B Four C Three D Two One E 5. A 28-year-old man is brought intoA&E with a reduced level of consciousness.His friends believe he has ingested large quantities of an unknown substance.He says words like“difficult”,“painful”,“doctor”.But she is not able to make full sentence.What is his verbal response score? A Five B Four Three C D Two One E LO 2 IDENTIFYTHE MECHANISMS OF NERVE CELL DAMAGEANDTHE RESPONSETO INJURY PRESENTED BY CHRISTOPHERWATANABE 1. A 25 year old male patient was drinking and he decided to“knife game” which resulted in the injury of his ring ringer.He has complete transection of nerve. If this is left untreated and nerve & artery in finger is not sutured back under microscope,what is the first thing that would happen? A Microphage infiltration B Breakdown of myelin sheath and debris by Schwann cells C Sprouting of new axon D Ca2+ ion enters the cytosol activating calpain Schwann cells de-differentiate and starts dividing but stays within basal lamina E 1. A 25 year old male patient was drinking and he decided to“knife game” which resulted in the injury of his ring ringer.He has complete transection of nerve. If this is left untreated and nerve & artery in finger is not sutured back under microscope,what is the first thing that would happen? A Microphage infiltration B Breakdown of myelin sheath and debris by Schwann cells C Sprouting of new axon D Ca2+ ion enters the cytosol activating calpain Schwann cells de-differentiate and starts dividing but stays within basal lamina E 2. 72 year old female was driving and she has mistaken acceleration pedal with deceleration pedal.This has resulted in the car colliding into the wall.She had no major external injury due to the air bag activating.However she seems to have lost consciousness in the car and she has not waken up from her coma.CT images were taken to investigate the cause of her symptoms.Which diagnosis best fits the description? A Extradural haematoma B Subdural haematoma C Subarachnoid haemorrhage D Diffuse axonal injury Intracerebral haemorrhages E2. 72 year old female was driving and she has mistaken acceleration pedal with deceleration pedal.This has resulted in the car colliding into the wall.She had no major external injury due to the air bag activating.However she seems to have lost consciousness in the car and she has not waken up from her coma.CT images were taken to investigate the cause of her symptoms.Which diagnosis best fits the description? 2. 72 year old female was driving and she has mistaken acceleration pedal with deceleration pedal.This has resulted in the car colliding into the wall.She had no major external injury due to the air bag activating.However she seems to have lost consciousness in the car and she has not waken up from her coma.CT images were taken to investigate the cause of her symptoms.Which diagnosis best fits the description? A Extradural haematoma B Subdural haematoma C Subarachnoid haemorrhage D Diffuse axonal injury Intracerebral haemorrhages E 3. 54 year old male patient is undergoing recovery after ischaemic stroke.In the frontal & temporal lobe there has been cell death due to ischaemia.Because of this,there is response by CNS in response to this injury.What cell is most involved in the removal of debris in this response? A Astrocytes B Microglial cells C Oligodendrocytes D Schwann cells Ependymal cells E 3. 54 year old male patient is undergoing recovery after ischaemic stroke.In the frontal & temporal lobe there has been cell death due to ischaemia.Because of this,there is response by CNS in response to this injury.What cell is most involved in the removal of debris in this response? A Astrocytes B Microglial cells C Oligodendrocytes D Schwann cells Ependymal cells E 4. You are 2nd year medical student and is currently learning about the mechanism which causes apotheosis of neurones.You learn that certain neurotransmitter allows for entry of na+ and ca2+.What neurotransmitter cause this excitotoxicity? A GABA B Serotonin C Glutamate D Dopamine Noradrenaline E 4. You are 2nd year medical student and is currently learning about the mechanism which causes apotheosis of neurones.You learn that certain neurotransmitter allows for entry of na+ and ca2+.What neurotransmitter cause this excitotoxicity? A GABA B Serotonin C Glutamate D Dopamine Noradrenaline E 5. You are 2nd year medical student and you just had lecture on oxidative stress which can be seen in almost all tissues including brain.Which of the following enzymes are involved in the removal of reactive oxygen species (ROS)? A Superoxide Dismutase B Phospholipase C Lysozyme D Capsases Oxidases E 5. You are 2nd year medical student and you just had lecture on oxidative stress which can be seen in almost all tissues including brain.Which of the following enzymes are involved in the removal of reactive oxygen species (ROS)? A Superoxide Dismutase B Phospholipase C Lysozyme D Capsases Oxidases E LO 3 RELATETHE CHANGES IN INTRACRANIAL PRESSURETO BRAIN FUNCTION PRESENTED BY CHRISTOPHERWATANABE 1. A 61 year old female patient presents to the ED after acute onset of confusion and impairment in short-term memory. After a CT image,large lesion in the brain are found.And with a MRI,it is confirmed to be a brain tumour. What is the compensatory mechanism prevents sudden increase in ICP? A Compression of brain parenchyma B Increased venous drainage via dural venous sinus C Decreased CSF drainage via ventricular systems D Increased CSF production by ependymal cells Destruction of cranium E 1. A 61 year old female patient presents to the ED after acute onset of confusion and impairment in short-term memory. After a CT image,large lesion in the brain are found.And with a MRI,it is confirmed to be a brain tumour. What is the compensatory mechanism prevents sudden increase in ICP? A Compression of brain parenchyma B Increased venous drainage via dural venous sinus C Decreased CSF drainage via ventricular systems D Increased CSF production by ependymal cells Destruction of cranium E 2. A 63 year old male has a subdural haematoma and results in compression of the brain parenchyma.The patient’s eye is looking“down & out” and is dilated.The patient seems to be dragging his own feet as he moves. What is the most likely type of herniation given the patient’s signs & symptoms? A Uncal Herniation B Central Herniation C Cingulate Herniation D Tonsillar Herniation Transcalvarial Herniation E 2. A 63 year old male has a subdural haematoma and results in compression of the brain parenchyma.The patient’s eye is looking“down & out” and is dilated.The patient seems to be dragging his own feet as he moves. What is the most likely type of herniation given the patient’s signs & symptoms? A Uncal Herniation B Central Herniation C Cingulate Herniation D Tonsillar Herniation Transcalvarial Herniation E 3. 32 year old female patient presents to the ed after hitting the head on the metal bars in the playground and bleeding profusely from the scalp.You find out that her blood pressure is 129/80 mmhg and that her cerebral perfusion pressure is 60mmhg.What is the intracranial pressure which can be estimated from the measurement provided in the description (rounding up to whole numbers)? A 30mmHg B 32mmHg C 34mmHg D 36mmHg 38mmHg E 3. 32 year old female patient presents to the ed after hitting the head on the metal bars in the playground and bleeding profusely from the scalp.You find out that her blood pressure is 129/80 mmhg and that her cerebral perfusion pressure is 60mmhg.What is the intracranial pressure which can be estimated from the measurement provided in the description (rounding up to whole numbers)? A 30mmHg B 32mmHg C 34mmHg D 36mmHg 38mmHg E 4. 50 year old female patient presents to ED after thunder-clap headache.Upon imaging the patient,she is found to have subarachnoid haemorrhage.There is increased intracranial pressure from haemorrhage.What is the three feature which can be seen in this patient? A Headache, Nuchal rigidity, Photophobia B Headache, Nausea, Confusion C Irregular respiration, Bradycardia, Systolic hypertension D Muffled heart sounds, Distended neck veins, Hypotension Jaundice, Fever, RUQ pain E 4. 50 year old female patient presents to ED after thunder-clap headache.Upon imaging the patient,she is found to have subarachnoid haemorrhage.There is increased intracranial pressure from haemorrhage.What is the three feature which can be seen in this patient? A Headache, Nuchal rigidity, Photophobia B Headache, Nausea, Confusion C Irregular respiration, Bradycardia, Systolic hypertension D Muffled heart sounds, Distended neck veins, Hypotension Jaundice, Fever, RUQ pain E 5. You are a 2nd year medical student and you are learning about the different factors which affect increase or decrease in ICP.And during CBL sessions,you are given a example of patient with subarachnoid haemorrhage in ED.What can be done for this patient to decrease ICP? A Coughing B Hyperventilation C Anticoagulant Use D Hypoventilation Propofol Use E 5. You are a 2nd year medical student and you are learning about the different factors which affect increase or decrease in ICP.And during CBL sessions,you are given a example of patient with subarachnoid haemorrhage in ED.What can be done for this patient to decrease ICP? A Coughing B Hyperventilation C Anticoagulant Use D Hypoventilation Propofol Use E 5. You are a 2nd year medical student and you are learning about the different factors which affect increase or decrease in ICP.And during CBL sessions,you are given a example of patient with subarachnoid haemorrhage in ED.What can be done for this patient to decrease ICP? A Coughing B Hyperventilation C Anticoagulant Use D Hypoventilation Propofol Use E LO 4 Describe the mechanisms of neck injury and the role of stabilisation PRESENTED BY CHRISTOPHERWATANABE 1. You are 2 year medical student and you have just witnessed a person falling down the the stairs.She is found unresponsive with no signs of life.An ambulance is called for immediately and basic life support is initiated.Due to the dangerous mechanism,a cervical spine injury is suspected. Which of the following is the best way to manage the airway in this setting? A Perform no basic airway manoeuvres B Insert oropharyngeal airway C Head tilt D Head tilt and chin lift Jaw thrust E 1. You are 2 year medical student and you have just witnessed a person falling down the the stairs.She is found unresponsive with no signs of life. An ambulance is called for immediately and basic life support is initiated.Due to the dangerous mechanism,a cervical spine injury is suspected. Which of the following is the best way to manage the airway in this setting? A Perform no basic airway manoeuvres B Insert oropharyngeal airway C Head tilt D Head tilt and chin lift Jaw thrust E 2. A 32-year-old female lies on the ground after being thrown out of vehicle from traffic accident.. An ambulance is called for immediately and basic life support is initiated.Due to the dangerous mechanism,a cervical spine injury is suspected.Basic observation is as follows HR = 110bpm,RR = 21 What is the best next step for this patient? A Start CPR B Applying a rigid collar C 3-point C-spine immobilisation D Insert an oropharyngeal airway Put in a recovery position E 2. A 32-year-old female lies on the ground after being thrown out of vehicle from traffic accident.. An ambulance is called for immediately and basic life support is initiated.Due to the dangerous mechanism,a cervical spine injury is suspected.Basic observation is as follows HR = 110bpm,RR = 21 What is the best next step for this patient? A Start CPR B Applying a rigid collar 3-point C-spine immobilisation C D Insert an oropharyngeal airway Put in a recovery position E 3. 50-year-old man is brought to theA&E after being thrown out of the bicycle from decelerating suddenly. The injury is suspected to have caused a hyperextension of the head. On a CT scan,there is fracture through the pars interarticularis of C2 bilaterally. What type of fracture is seen on the CT scan? A Colles Fracture B Hangman’s Fracture C Smiths Fracture D Jefferson Fracture Odontoid peg Fracture E 3. 50-year-old man is brought to theA&E after being thrown out of the bicycle from decelerating suddenly. The injury is suspected to have caused a hyperextension of the head. On a CT scan,there is fracture through the pars interarticularis of C2 bilaterally. What type of fracture is seen on the CT scan? A Colles Fracture B Hangman’s Fracture C Smiths Fracture D Jefferson Fracture Odontoid peg Fracture E 4. A 72-year-old female is found to have cervical facet subluxation at the level of C2 upon CT scan.Due to her COPD,she is assessed asASA grade III and her operative risk is high. What is the most definitive management for this patient? A Using a traction device B Using a rigid C-spine collar C Surgical reduction and stabilisation D Surgical fixation using screws Using a halo vests E 4. A 72-year-old female is found to have cervical facet subluxation at the level of C2 upon CT scan.Due to her COPD,she is assessed asASA grade III and her operative risk is high. What is the most definitive management for this patient? A Using a traction device B Using a rigid C-spine collar C Surgical reduction and stabilisation D Surgical fixation using screws Using a halo vests E 5. A 52-year-old male is found in car unconscious after he lost control of his vehicle and drove off the cliff.He hit back of his head against the roof of vehicle.He is given a CT-scan and he is found to have burst fracture at C1. What type of fracture is seen in this patient? A Hangman fracture B Calcaneal fracture C Jefferson fracture D Clavicle fracture Lisfranc injury E 5. A 52-year-old male is found in car unconscious after he lost control of his vehicle and drove off the cliff.He hit back of his head against the roof of vehicle.He is given a CT-scan and he is found to have burst fracture at C1. What type of fracture is seen in this patient? A Hangman fracture B Calcaneal fracture C Jefferson fracture D Clavicle fracture Lisfranc injury E LO 5 LO HOHIN LAMLO5:DESCRIBETHEANATOMICAL PATHWA Y OFTHE CRANIAL NERVESANDTHEIR FUNCTION SBA QUESTION:WHICH OFTHE BELLOW SYMPTOMSWOULD HELP DIFFERENTIATE BETWEEN UPPER MOTOR NEURONAND LOWER MOTOR NEURON NERVE PALSY A Ptosis B Change in hearing C Facial droop D Pupils constriction E Unable to lift eyebrows SBA QUESTION:WHICH OFTHE BELLOW SYMPTOMSWOULD HELP DIFFERENTIATE BETWEEN UPPER MOTOR NEURONAND LOWER MOTOR NEURON NERVE PALSY A Ptosis B Change in hearing C Facial droop D Pupils constriction E Unable to lift eyebrowsSBA QUESTION:WHICH OFTHE FOLLOWING NERVE IS LIKELYAFFECTEDWHEN PATIENT PRESENTSWITHTHIS A Glossopharyngeal nerve B Vagus nerve C Hypoglossal nerve D Facial nerve E Mandibular branch of trigeminal nerveSBA QUESTION:WHICH OFTHE FOLLOWING NERVE IS LIKELYAFFECTEDWHEN PATIENT PRESENTSWITHTHIS A Glossopharyngeal nerve B Vagus nerve C Hypoglossal nerve D Facial nerve E Mandibular branch of trigeminal nerve SBA QUESTION:PATIENT PRESENTSWITH UNILATERAL LEFT EYE DEVIATION DOWNWARDS AND OUTWARDSWITH PTOSISAND PUPIL DILATIONWHICH NERVE IS MOST LIKELYTO BE AFFECTED A Oculomotor nerve B Trochlear nerve C Abducens nerve D Optic nerve SBA QUESTION:PATIENT PRESENTSWITH UNILATERAL LEFT EYE DEVIATION DOWNWARDS AND OUTWARDSWITH PTOSISAND PUPIL DILATIONWHICH NERVE IS MOST LIKELYTO BE AFFECTED A Oculomotor nerve B Trochlear nerve C Abducens nerve D Optic nerve SBA QUESTION:THE PATIENT PRESENTSWITH HOMONYMOUS LEFT LOW QUADRANT QUADRANTANOPIA ,WHERE ISTHE LEISION LIKELYTO BE A Right optic nerve B Optic chiasm C Left temporal lobe optic radiation D Left parietal lobe optic radiation E Left occipital lobe SBA QUESTION:THE PATIENT PRESENTSWITH HOMONYMOUS LEFT LOW QUADRANT QUADRANTANOPIA ,WHERE ISTHE LEISION LIKELYTO BE A Right optic nerve B Optic chiasm C Left temporal lobe optic radiation D Left parietal lobe optic radiation E Left occipital lobe SBA QUESTION:WHICH OFTHE FOLLOWING NERVE GIVES RISETOTHE RECURRENT LARYNGEAL NERVE A Accessory nerve B Hypoglossalpharyngeal nerve C Laryngeal nerve D Vagus nerve E Glossopharyngeal nerve SBA QUESTION:WHICH OFTHE FOLLOWING NERVE GIVES RISETOTHE RECURRENT LARYNGEAL NERVE A Accessory nerve B Hypoglossalpharyngeal nerve C Laryngeal nerve D Vagus nerve E Glossopharyngeal nerveLO6:DESCRIBETHE STRUCTUREAND FUNCTION OFTHE MENINGES SBA QUESTION:WHICH OFTHE FOLLOWING DRUGSWORKS IN EARLY STAGES OF MENINGITIS BUTARE NOT EFFECTIVE LATER ON A Metronidazole B Ceftriaxone C Vancomycin D Penicillin E Meropenem SBA QUESTION:WHICH OFTHE FOLLOWING DRUGSWORKS IN EARLY STAGES OF MENINGITIS BUTARE NOT EFFECTIVE LATER ON A Metronidazole B Ceftriaxone C Vancomycin D Penicillin E Meropenem SBA QUESTION:WHICHARTERY IS MOST LIKELYTO BE DAMAGED IN BLUNTTRAUMA TOTHE SIDE OFTHE HEAD A Anterior cerebral artery B Posterior cerebral artery C Middle meningeal artery D Middle cerebral artery E Basilar artery SBA QUESTION:WHICHARTERY IS MOST LIKELYTO BE DAMAGED IN BLUNTTRAUMA TOTHE SIDE OFTHE HEAD A Anterior cerebral artery B Posterior cerebral artery C Middle meningeal artery D Middle cerebral artery E Basilar artery SBA QUESTION:WHICH PART OFTHE MENINGES DOESTHE BRAIN CROSS DURINGA HERNIATION A Falx cerebri B Tentorium cerebelli C Diaphagma sellae D Falx cerebelli SBA QUESTION:WHICH PART OFTHE MENINGES DOESTHE BRAIN CROSS DURINGA HERNIATION A Falx cerebri B Tentorium cerebelli C Diaphagma sellae D Falx cerebelli SBA QUESTION:WHICHTYPE OF HYDROCEPHALUS IS LIKELYTO BE CAUSED BY MENINGITIS A Communicating hydrocephalus B Non-Communicating hydrocephalus C Normal pressure hydrocephalus D Hydrocephalus ex-vacuo SBA QUESTION:WHICHTYPE OF HYDROCEPHALUS IS LIKELYTO CAUSE BY MENINGITIS A Communicating hydrocephalus B Non-Communicating hydrocephalus C Normal pressure hydrocephalus D Hydrocephalus ex-vacuoLO7:OUT LINETHE MICROBIOLOGY FOR CNS INFECTIONS SBA QUESTION: A CHILD PRESENTS INTHEA&EWITH SYMPTOMS OF MENINGITIS,UPON FURTHER QUESTIONINGTHE CHILD HAS BEEN FULLYVACCINATED UPTO DATE,WHAT ISTHE MOST LIKELY CAUSATIVEAGENT A Haemophilus influezae type B B Japanese EncephalitisVrius C Menningococcal group B D Yellow fever virus E Streptococcus pneumoniae SBA QUESTION: A CHILD PRESENTS INTHEA&EWITH SYMPTOMS OF MENINGITIS,UPON FURTHER QUESTIONINGTHE CHILD HAS BEEN FULLYVACCINATED UPTO DATE,WHAT ISTHE MOST LIKELY CAUSATIVEAGENT A Haemophilus influezae type B B Japanese EncephalitisVrius C Menningococcal group B D Yellow fever virus E Streptococcus pneumoniae SBA QUESTION:PATIENT IS BEING INVESTIGATED FOR MENINGITIS;LUMBAR PUNCTURE RESULTS ISAS FOLLOWS:PRESSURE – HIGH;CSF –YELLOW;INCREASE NEUTROPHIL COUNTS; NORMAL LYMPHOCYTE COUNTS;DECREASED GLUCOSE;WHICH OFTHE FOLLOWING ISTHE LIKELYTYPE OF CAUSATIVEAGENT A Bacteria B Viral C Fungal D Autoimmune SBA QUESTION:PATIENT IS BEING INVESTIGATED FOR MENINGITIS;LUMBAR PUNCTURE RESULTS ISAS FOLLOWS:PRESSURE – HIGH;CSF –YELLOW;INCREASE NEUTROPHIL COUNTS; NORMAL LYMPHOCYTE COUNTS;DECREASED GLUCOSE;WHICH OFTHE FOLLOWING ISTHE LIKELYTYPE OF CAUSATIVEAGENT A Bacteria B Viral C Fungal D Autoimmune SBA QUESTION:LUMBAR PUNCTUREAS FOLLOWS:CSFYELLOWWITH NORMAL PRESSURE, NORMAL GLUCOSE;INCREASED PROTEIN;INCREASED LYMPHOCYTES;WHICH OFTHE FOLLOWINGWOULD DOES NOT HELP GUIDE DIFFERENTIALS A Blood culture B Occupation history C CD4 cell counts counts D HPV vaccination history E Mantoux test SBA QUESTION:LUMBAR PUNCTUREAS FOLLOWS:CSFYELLOWWITH NORMAL PRESSURE, NORMAL GLUCOSE;INCREASED PROTEIN;INCREASED LYMPHOCYTES;WHICH OFTHE FOLLOWINGWOULD DOES NOT HELP GUIDE DIFFERENTIALS A Blood culture B Occupation history C CD4 cell counts counts D HPV vaccination history E Mantoux test SBA QUESTION:WHICH OFTHE FOLLOWING ORGANISM IS MOST COMMONLY SEEN IN HIV PATIENTS PRESENTINGWITH MENINGITIS A Candida albicans B Cryptococcus neoformans C Aspergillus s D Histoplasma capsulatum E Mucorales SBA QUESTION:WHICH OFTHE FOLLOWING ORGANISM IS MOST COMMONLY SEEN IN HIV PATIENTS PRESENTINGWITH MENINGITIS A Candida albicans B Cryptococcus neoformans C Aspergillus s D Histoplasma capsulatum E Mucorales SBA QUESTION: PATIENT FROM KOREA PRESENTSWITH:FEVER;HEADACHE;NAUSEAAND VOMITINGAND GENERALIZEDTONIC SEIZURES,WHAT ISTHE LIKELY CAUSATIVEAGENTS A HSV-1 B Japanese encephalitis virus C West niles virus D Meningitis B E Neisseria meningitidis SBA QUESTION: PATIENT FROM KOREA PRESENTSWITH:FEVER;HEADACHE;NAUSEAAND VOMITINGAND GENERALIZEDTONIC SEIZURES,WHAT ISTHE LIKELY CAUSATIVEAGENTS A HSV-1 B Japanese encephalitis virus C West niles virus D Meningitis B E Neisseria meningitidisLO7:DESCRIBETHE PHARMACOLOGICAL MANAGEMENT FOR REDUCING INTRACRANIAL SWELLING SBA QUESTION:WHICH OFTHE FOLLOWING DRUG IS USEDTOAVOIDACUTE BRAIN HERNIATIONASA RESULT OFACUTE INTRACRANIAL HYPERTENSION DUETOA BRAINABSCESS A IV CEFTTRIAXONE + METRONIDAZOLE B HYPOTONIC SALINE C MANNITOL D CORTICOSTEROIDS E FUROSEMIDE SBA QUESTION:WHICH OFTHE FOLLOWING DRUG IS USEDTOAVOIDACUTE BRAIN HERNIATIONASA RESULT OFACUTE INTRACRANIAL HYPERTENSION DUETOA BRAINABSCESS A IV CEFTTRIAXONE + METRONIDAZOLE B HYPOTONIC SALINE C MANNITOL D CORTICOSTEROIDS E FUROSEMIDE SBA QUESTION:WHAT IS DEFINITIVE METHODTO REDUCE ICH FOR PATIENTSWITHA CONFIRMED DIAGNOSIS OF SUBARACHNOID HAEMORRHAGE A Mannitol B Nimodipine C Furosemide D Hypotonic saline E Low-molecular weight heparin SBA QUESTION:WHAT IS DEFINITIVE METHODTO REDUCE ICH FOR PATIENTSWITHA CONFIRMED DIAGNOSIS OF SUBARACHNOID HAEMORRHAGE A Mannitol B Nimodipine C Furosemide D Hypotonic saline E Low-molecular weight heparin SBA QUESTION:WHY MIGHT MANNITOL BE CONTRAINDICATED IN MANAGING RAIDED INTRACRANIAL PRESSURE A ANURIA B ASTHMA C EXTERNALVENTRICULAR DRAINALREADY PLACED D PATIENT ON CALCIUM INFUSIONALREADY E ACUTE KIDNEY INJURY SBA QUESTION:WHY MIGHT MANNITOL BE CONTRAINDICATED IN MANAGING RAIDED INTRACRANIAL PRESSURE A ANURIA B ASTHMA C EXTERNALVENTRICULAR DRAINALREADY PLACED D PATIENT ON CALCIUM INFUSIONALREADY E ACUTE KIDNEY INJURY SBA QUESTION: WHICH OFTHE FOLLOWING CLINICAL FEATUREWOULD MAKEA PATIENT WITH BRAINABSCESS ( EMPYEMA )A SUITABLE CANDIDATE FOR PHARMACOLOGICAL MANAGEMENT INSTEAD OF SURGICAL A Focal abscess >2.5cm B Multi focal abscess <2.5cm C Older patients D GCS <12 E Unknown microorganism etiology SBA QUESTION: WHICH OFTHE FOLLOWING CLINICAL FEATUREWOULD MAKEA PATIENT WITH BRAINABSCESS ( EMPYEMA )A SUITABLE CANDIDATE FOR PHARMACOLOGICAL MANAGEMENT INSTEAD OF SURGICAL A Focal abscess >2.5cm B Multi focal abscess <2.5cm C Older patients D GCS <12 E Unknown microorganism etiology LO’S CASE 13 (NEURO) H9.RELATETHE UNDERLYING PATHOLOGICAL CHANGESTOTHE CLINICAL PRESENTATION OF DIFFERENT NEUROLOGICAL CONDITIONS H10.OUTLINETHE DIFFERENT NEURO-RADIOLOGICAL INVESTIGATIONSAVAILABLE FOR DIAGNOSIS OF NEUROLOGICAL CONDITIONS H11. ASSESSTHE SOCIAL IMPACT OF STIGMA CAUSED BY ILLNESS OR INJURY ON PATIENT EXPERIENCEAND RELATETHISTO CLINICAL PRACTICE H12.IDENTIFYAND DESCRIBETHE COMPONENT PARTS OFTHEAIRWAY,INCLUDINGADJACENT STRUCTURESAND EXPLAINTHEIR IMPORTANCE WITH REGARDSTO MAINTAININGTHEAIRWAY INA CLINICAL SETTING. PRESENTED BY:ŞAYLAN MEHMETLEARNING OBJECTIVE: ¡ H9.RELATETHE UNDERLYING PATHOLOGICAL CHANGESTOTHE CLINICAL PRESENTATION OF DIFFERENT NEUROLOGICAL CONDITIONSQ1: ¡ What is the definition of a transient ischaemic attack (TIA)? SBA QUESTION A Transient episode of neurological dysfunction with acute infarction and tissue injury B Transient episode of neurological dysfunction with acute infarction but without tissue injury C Transient episode of neurological dysfunction without acute infarction and with tissue injury D Transient episode of neurological dysfunction without acute infarction or tissue injury E Transient episode of neurological dysfunction with resolution within 7 days. SBA QUESTION A Transient episode of neurological dysfunction with acute infarction and tissue injury B Transient episode of neurological dysfunction with acute infarction but without tissue injury C Transient episode of neurological dysfunction without acute infarction and with tissue injury D Transient episode of neurological dysfunction without acute infarction or tissue injury E Transient episode of neurological dysfunction with resolution within 7 days.Q2: A 2-MONTH-OLD BABY ISADMITTED INTO HOSPITALWITH SYMPTOMS OF MENINGITIS. A LUMBAR PUNCTURE IS PERFORMED, ANDA CSF CULTURE REVEALSTHE CAUSATIVE ORGANISMTO BE LISTERIA MONOCYTOGENESE.WHATWERETHE MOST LIKELY LUMBAR PUNCTURE RESULTS? SBA QUESTION A Clear CSF, normal polymorphs,elevated lymphocytes,normal protein and glucose B Yellow CSF,elevated polymorphs,normal lymphocytes,elevated protein,decreased glucose C Clear CSF, normal polymorphs,lymphocytes,protein and glucose D Yellow CSF,normal polymorphs,elevated lymphocytes,raised protein,decreased glucose E Yellow CSF,normal polymorphs,elevated lymphocytes,normal protein,normal or decreased glucose SBA QUESTION A Clear CSF, normal polymorphs,elevated lymphocytes,normal protein and glucose B Yellow CSF,elevated polymorphs,normal lymphocytes,elevated protein,decreased glucose C Clear CSF, normal polymorphs,lymphocytes,protein and glucose D Yellow CSF,normal polymorphs,elevated lymphocytes,raised protein,decreased glucose E Yellow CSF,normal polymorphs,elevated lymphocytes,normal protein,normal or decreased glucoseQ3: ¡ A PATIENT SUFFERSA STROKEAND PRESENTSTOTHE EDWITHTHE FOLLOWING SIGNSAND SYMPTOMS: ¡ CONTRALATERAL HEMIPARESISAND SENSORY LOSS OFTHE UPPER LIMBSANDTRUNK> LOWER LIMBS,CONTRALATERAL HOMONYMOUS HEMIANOPIAANDAPHASIA. ¡ WHAT ISTHE MOST LIKELY LOCATION OFTHE STROKE? SBA QUESTION A Anterior cerebral artery (ACA) B Middle cerebral artery (MCA) C Posterior cerebral artery (PCA) D Posterior inferior cerebellar artery E Anterior inferior cerebellar artery SBA QUESTION A Anterior cerebral artery (ACA) B Middle cerebral artery (MCA) C Posterior cerebral artery (PCA) D Posterior inferior cerebellar artery E Anterior inferior cerebellar arteryQ4: ¡ An 56 year old man is involved in a high impact trauma and presents to the ED with confusion, nausea and a worsening headache.He is taken to CT and you are asked to review the imaging and come up with a definitive treatment for his acute presentation.What is the definitive treatment for this case? SBA QUESTION A Clinical and radiological observation B Craniotomy C Craniectomy D Burr holes E Mannitol SBA QUESTION A Clinical and radiological observation B Craniotomy C Craniectomy D Burr holes E MannitolQ5: ¡ A 45 year old man was involved in a pub fight and falls over backwards hitting his head on the pavement.Upon arrival to the ED following an A-E assessment,you order a head CT. Whilst waiting for the CT,you take a closer look at his face.Based off of what you see to get ahead,you think about the possible locations of the injury. Which bones do you suspect trauma could have occurred to ? SBA QUESTION A Frontal,temporal,parietal B Frontal,temporal,zygomatic C Nasal,ethmoid,vomer D Temporal,zygomatic,mandibular E Frontal,temporal,occipital SBA QUESTION A Frontal,temporal,parietal B Frontal,temporal,zygomatic C Nasal,ethmoid,vomer D Temporal,zygomatic,mandibular E Frontal,temporal,occipitalLEARNING OBJECTIVE: ¡ H10.OUTLINETHE DIFFERENT NEURO-RADIOLOGICAL INVESTIGATIONSAVAILABLE FOR DIAGNOSIS OF NEUROLOGICAL CONDITIONSQ1: ¡ A MAN SUFFERSA BLOWTOTHE HEADAND LOSES CONSCIOUSNESS.HE REGAINS CONSCIOUSNESSAND IS CONVINCEDTO GOTO HOSPITALWHEREYOU MEET HIM.HE COMPLAINS OF HEADACHESAND SHORTLYAFTER LOSES CONSCIOUSNESSAGAIN. ¡ WHATTYPE OF IMAGING DOYOU REQUESTTO HELP CONFIRMA DIAGNOSIS OFAN EXTRADURAL HAEMATOMA? SBA QUESTION A MRI B CT non-contrast C X-ray D CT with contrast E Bone scan SBA QUESTION A MRI B CT non-contrast C X-ray D CT with contrast E Bone scanQ2: ¡ AWOMAN PRESENTSTO HOSPITALWITH FEVERS, HEADACHESAND FOCAL NEUROLOGICAL DEFICITS.AFTER BEDSIDEAND BLOOD INVESTIGATIONS,YOU SEND HER FOR IMAGING FORA SUSPECTED INTRACEREBRALABSCESS.WHAT IMAGING IS MOST LIKELY DONE? SBA QUESTION A MRI B CT non-contrast C X-ray D CT with contrast E Bone scan SBA QUESTION A MRI B CT non-contrast C X-ray D CT with contrast E Bone scanQ3: AWOMANWITH KNOWN POLYCYSTIC KIDNEY DISEASE (PKD) COMPLAINS OF HEADACHESAND INFORMEDTHATTHIS DISEASE IS LINKEDWITHTHE POTENTIALTO DEVELOP INTRACRANIALANEURYSMS, PARTICULARLY OFTHEANTERIOR COMMUNICATINGARTERY (CALLEDA ’BERRY ANEURYSM’). SHE UNDERGOES IMAGINGANDTHE PICTURE ONTHE RIGHT IS OBTAINED.WHAT KIND OF IMAGING HAS BEEN PERFORMED? SBA QUESTION A MRI head B PET-CT C CT non-contrast head D CT intracranial angiogram E CT contrast head SBA QUESTION A MRI head B PET-CT C CT non-contrast head D CT intracranial angiogram E CT contrast headQ4: ¡ AWOMEN ISADMITTEDTO HOSPITAL FOLLOWINGA SUDDEN UNPROVOKED SEIZURE. SHE HAS NO SIGNIFICANT PMHX OR HISTORY OF SEIZURES.WHAT ISTHE FIRST LINE INVESTIGATIVE IMAGING DONE? SBA QUESTION A MRI B CT C X-RAY D CT-angiogram E PE-CT SBA QUESTION A MRI B CT C X-RAY D CT-angiogram E PE-CT Q5: ¡ NAMETHE RADIOLOGICAL IMAGING: 1 2 3 SBA QUESTION A 1 = CT 2= MRIT1 3= MRIT2 B 1= CT 2=MRIT2 3=MRIT1 C 1=MRIT1 2=CT 3=MRIT2 D 1=MRIT2 2=MRIT1 3=CT E 1= MRIT2 2=CT 3=MRIT1 SBA QUESTION A 1 = CT 2= MRIT1 3= MRIT2 B 1= CT 2=MRIT2 3=MRIT1 C 1=MRIT1 2=CT 3=MRIT2 D 1=MRIT2 2=MRIT1 3=CT E 1= MRIT2 2=CT 3=MRIT1LEARNING OBJECTIVE: ¡ H11.ASSESSTHE SOCIAL IMPACT OF STIGMA CAUSED BY ILLNESS OR INJURY ON PATIENT EXPERIENCEAND RELATETHISTO CLINICAL PRACTICEQ1: ¡ FOLLOWING NEUROSURGERY,THE PATIENT MAY EXPERIENCE SOME DEFICITSTHATTHEY DID NOT BEFOREAND MAY REQUIREADJUSTMENTSTOTHEIR HOUSETO HELPTHEM GET AROUNDANDTO COPEWITHTHEIR DEFICITS.WHOWOULDYOU CONTACTTO HELP ORGANIZETHESEADJUSTMENTS? SBA QUESTION A Occupational therapist B Physiotherapists C Speech and language therapists D Advanced nurse practitioners E Neurologist SBA QUESTION A Occupational therapist B Physiotherapists C Speech and language therapists D Advanced nurse practitioners E NeurologistQ2: ¡ FOLLOWING BRAIN SURGERY,ORANY KIND OF DEPRESSED SKULL FRACTURE,A PERSON ISAT RISK OF DEVELOPING SEIZURES.DURINGA SEIZURE,WHAT SHOULDYOU NOT DO? SBA QUESTION A Cushion the patient’s head B Turn their head to one side/ the person onto their side to help with breathing C Move items that may cause injury to the patient D Stay with the person until they’re fully recovered E Restrain the person to hold them still SBA QUESTION A Cushion the patient’s head B Turn their head to one side/ the person onto their side to help with breathing C Move items that may cause injury to the patient D Stay with the person until they’re fully recovered E Restrain the person to hold them stillQ3: ¡ NEUROBEHAVIOURAL DISABILITY (NBD) CAN FOLLOW BRAIN INJURY,COMMONLYTHOSE OFTRAUMATIC NATURE.NBD CAN HAVE SERIOUS IMPACTS ONA PERSON’S DECISION- MAKINGAND CAPACITY FOR SOCIAL INDEPENDENCE.WHICH OFTHE FOLLOWING IS NOTA FORM OF NBD? SBA QUESTION A Executive and attentional dysfunction B Poor insight,problems with awareness and social judgement C Labile mood and altered emotional control,aggression D Problems reading,writing and speaking E Problems with drive/motivation SBA QUESTION A Executive and attentional dysfunction B Poor insight,problems with awareness and social judgement C Labile mood and altered emotional control,aggression D Problems reading,writing and speaking E Problems with drive/motivationQ4: ¡ ONE FORM OF NBDAS MENTIONED ISAGGRESSIVE BEHAVIOUR FOLLOWING BRAIN INJURY. TO UNDERSTANDAGGRESSIONAND ITS IMPACT ONA PATIENT’S PSYCHOSOCIAL OUTCOMESAFTER BRAIN INJURY,A SCALE CAN BE USEDTOASSESSTHE SEVERITY OFTHE AGGRESSION.WHICH SCALE CAN BE USEDTO DOTHIS? SBA QUESTION A OAS-MNR B CURB-65 C WELLS D ORBIT E FACED SBA QUESTION A OAS-MNR B CURB-65 C WELLS D ORBIT E FACEDQ5: ¡ IN SOME INSTANCES,BRAIN INJURY CAN LEADTO MENTAL HEALTH PROBLEMS SUCHAS DEPRESSION,ANXIETY COGNITIVE ISSUESAND PROBLEMSWITH REGULATING BEHAVIOUR.ASWITH MENTAL HEALTH PROBLEMSWITHOUT BRAIN INJURY,THIS CAN RESULT IN STIGMAAND FURTHER PSYCHOSOCIAL PROBLEMSTHROUGH NOT SEEKING OUTTHEAPPROPRIATE HELP.MANYTEAMSARE INVOLVED IN DEALINGWITH MENTAL HEALTH PROBLEMSARISING FROM BRAIN INJURY,WHICH OFTHE FOLLOWING HCPS CAN HELP? SBA QUESTION A Clinical psychologists B Neuropsychologists C Neuropsychiatrists D Mental health crisis team E All of the above SBA QUESTION A Clinical psychologists B Neuropsychologists C Neuropsychiatrists D Mental health crisis team E All of the aboveLEARNING OBJECTIVE: ¡ H12.IDENTIFYAND DESCRIBETHE COMPONENT PARTS OFTHE AIRWAY,INCLUDINGADJACENT STRUCTURESAND EXPLAIN THEIR IMPORTANCEWITH REGARDSTO MAINTAININGTHE AIRWAY INA CLINICAL SETTING.Q1: NAME EACH OFTHE PARANASAL SINUSES: SBA QUESTION A 1 Frontal, 2 maxillary, 3 ethmoid and 4 sphenoid B 1 maxillary, 2 ethmoid,3 sphenoid and 4 frontal C 1 ethmoid, 2 sphenoid,3 frontal and 4 maxillary D 1 sphenoid, 2 frontal,3 maxillary and 4 ethmoid E 1 frontal,2 ethmoid, 3 sphenoid an d4 maxillary SBA QUESTION A 1 Frontal, 2 maxillary, 3 ethmoid and 4 sphenoid B 1 maxillary, 2 ethmoid,3 sphenoid and 4 frontal C 1 ethmoid, 2 sphenoid,3 frontal and 4 maxillary D 1 sphenoid, 2 frontal,3 maxillary and 4 ethmoid E 1 frontal,2 ethmoid, 3 sphenoid and 4 maxillaryQ2: ATWHATVERTEBRAL LEVELAND RIB LEVEL ISTHE CARINA LOCATED? SBA QUESTION A Rib 3,T4-5 B Rib 4,T3-4 C Rib 2,T4-5 D Rib3,T3-4 E Rib 2,T3-4 SBA QUESTION A Rib 3,T4-5 B Rib 4,T3-4 C Rib 2,T4-5 D Rib3,T3-4 E Rib 2,T3-4Q3: WHAT ISTHE NAME OFTHE ARTERY? SBA QUESTION A Greater palatine artery B Little’s area C Superior labial artery D Anterior ethmoidal artery E Sphenopalatine artery SBA QUESTION A Greater palatine artery B Little’s area C Superior labial artery D Anterior ethmoidal artery E Sphenopalatine arteryQ4: ¡WHICH NERVE ISTHE CRICOTHYROID MUSCLE INNERVATED BY? SBA QUESTION A Recurrent laryngeal nerve B Vagus nerve C Superior laryngeal nerve D Phrenic nerve E Inferior laryngeal nerve SBA QUESTION A Recurrent laryngeal nerve B Vagus nerve C Superior laryngeal nerve D Phrenic nerve E Inferior laryngeal nerveQ5: WHATARETHE NAMES OF THETONSILS? SBA QUESTION A Pharyngeal,tubal,palatine,lingual B Pharyngeal,tubal,palatine,lingual C Pharyngeal,tubal,palatine,lingual D Pharyngeal,tubal,palatine,lingual E Pharyngeal,tubal,palatine,lingual SBA QUESTION A Pharyngeal,tubal,palatine,lingual B Pharyngeal,tubal,palatine,lingual C Pharyngeal,tubal,palatine,lingual D Pharyngeal,tubal,palatine,lingual E Pharyngeal,tubal,palatine,lingualTHANKYOU FOR LISTENING ¡ Please ask any questions in the chat.