ABSTRACT
Question 49 A 35-year-old man has a 6-year history of relapsing and remitting neurological symptoms. During the last 2 years, he has had a 1-month episode of recurrent intense electric-shock-like pain affecting the left side of his face, which eventually stopped with carbamazepine. He recently had an episode of progressive weakness and heaviness in his left leg, and he was unable to walk on it for 2 weeks. The patient is referred to a neurologist for advice on his future management. Which of the following is the most appropriate management? Please choose the single best answer from the following answers: 1) Information and reassurance 2) Interferon 1-beta 3) Long-term oral antibiotics
4) Oral course of high-dose methylprednisolone for 5 days 5) Regular baclofen
Question 50 A 23-year-old woman develops worsening visual loss in her left eye over several days, associated with pain on moving the eye, particularly on looking up. On examination, she has reduced visual acuity in the left eye, and she has lost the perception of colour in the centre of her vision, but the fundi are normal. A swinging torch test shows a left afferent pupillary defect. Over the next 4 weeks, her vision returns to normal. Which of the following is the most likely diagnosis? Please choose the single best answer from the following answers: 1) Amaurosis fugax 2) Giant cell arteritis 3) Occipital lobe lesion 4) Optic neuritis 5) Orbital tumour
Question 51 A 30-year-old woman presents with vertigo, double vision, slurred speech and imbalance on walking. On examination, she has a right-sided dysmetria, brisk tendon reflexes, extensor plantar responses and an ataxic gait. She has a horizontal jerking nystagmus, worse on looking right, and a right internuclear ophthalmoplegia. Two years previously, she had a 4-week period of blurred vision in her left eye. Which investigation is most likely to confirm the diagnosis? Please choose the single best answer from the following answers: 1) Computed tomographic (CT) scan of the head 2) Full blood count 3) Midstream urine sample 4) Magnetic resonance imaging (MRI) scan of the head 5) Visually evoked responses
Question 52 A 48-year-old man presents with a 5-to 7-year history of gradual functional deterioration in his legs. For the last few years, he has noticed that his legs become stiff and heavy if he walks more than a couple of miles, and he has recently fallen over a few times. Over the last few months, he has been having problems with urinary frequency and nocturia. On examination, he has spastic paraparesis with brisk tendon reflexes and extensor plantar responses. Joint position sense is absent in the toes, and touch is reduced up to both knees. There are no eye movement, fundal or cranial nerve
abnormalities. Please choose the single best answer from the following answers: 1) Cervical myelopathy 2) Guillain-Barré syndrome 3) Primary progressive MS 4) Relapsing-remitting MS 5) Transverse myelitis
Answers Investigations: SBAs Answer 48 2) Multiple sclerosis: The history of neurological symptoms affecting the eye 1 year previously followed by upper motor symptoms in one leg is typical of MS.
Answer 49 2) Interferon 1-beta: This history suggests two severe episodes of relapsing MS over the last 2 years. Sharp facial pains suggest trigeminal neuralgia, which is a common presentation of MS. Patients with at least two relapses in 2 years often benefit from disease-modifying treatment such as Interferon 1-beta, which has been shown to reduce relapses by 30% in active relapsing-remitting MS.
