Pathology EMQ template.

Name: Grace Britton

Theme: Cerebrovascular Disease 2

 

OPTION LIST

 

A	Central pontine myelinolysis	I	Transient ischaemic attack
B	Cerebral Infarct – Anterior cerebral artery	J	Vaso-vagal syncope
C	Cerebral Infarct – Middle cerebral artery	K	Venous ischaemic syndrome
D	Locked-in Syndrome	L	Vascular Dementia
E	Subarachnoid Haemorrhage	M
F	Subarachnoid Haemorrhage with Berry Aneurysm	N
G	Subdural Haemorrhage	O
H	Temporal arteritis	P

 

 

For each scenario below, choose the most appropriate answer from the list above. Each option may be used once, more than once or not at all.

 

1. A 72-year-old patient with a life-long history of psoriasis has been admitted to hospital with pyrexia of unknown origin. Two days later, splinter haemorrhages ae noticed in his nail beds, with other evidence of microhaemorrhages such as Osler’s nodes and Janeway lesions. A transoesophageal ultrasound confirms a diagnosis of endocarditis. Antibiotic treatment is commenced. Later that day, the patient becomes increasingly confused, her limbs become limp and heavy, and her speech becomes aphasic.

 

2. A 39-year-old woman with polycystic kidneys and a previous admission to hospital for a severe headache is brought by her husband after she complained of a sudden headache, feeling as though she had been ‘kicked in the head.’ She is unconscious, and suffers a seizure in the examining room. Her husband says she was vomiting in the car.

 

 

3. A 76-year-old woman presents to A&E with slight unsteadiness and a headache, but without any neurological symptoms. Upon astute questioning, she admits to have suffered a small fall in the bathtub several weeks, but doesn’t think that is relevant. Upon examination, her pupils are asymmetrical. A CT scan demonstrates shifting midline structures.

 

4. An elderly 78-year-old man with a history of claudication has sudden blindness in one eye. In his history, he describes common headaches and pain when combing his hair. On examination, his pulse is weak.

 

5. A patient with a metal valve, on warfarin, presents with syncope and dizziness and complains of shaking limbs. However, his symptoms subside and eventually disappear later in the day.

 

 

 

ANSWERS

1. C

2. F

3. G

4. H

5. I