Pathology EMQ template.

Name: Zhoudi Dai

Theme: Cerebrovascular disease

OPTION LIST

A	Acute Extradural Haemorrhage	I	Left Posterior Inferior Cerebellar Artery (PICA) Occlusion
B	Acute Subdural Haemorrhage	J	Right Anterior Cerebral Occlusion
C	Chronic Extradural Haemorrhage	K	Right Middle Cerebral Occlusion
D	Chronic Subdural Haemorrhage	L	Right Posterior Cerebral Occlusion
E	Lacunar Infarction	M	Right Posterior Inferior Cerebellar Artery (PICA) Occlusion
F	Left Anterior Cerebral Occlusion	N	Watershed Infarction
G	Left Middle Cerebral Occlusion	O	Weber’s syndrome
H	Left Posterior Cerebral Occlusion	P	Vascular/Multi-infarct Dementia

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 70 year man old presented with acute onset of vertigo. On neurological examination he has left-sided loss of pain and temperature sensation with partial right-sided ptosis and miosis as well as right sided diplopia. He has a mild left-sided weakness and an ataxic gait. He reports numbness on the right side of his face.

2. A 70 year old man with a history of congestive heart failure presents with bilateral visual loss. On examination there is weakness in the proximal limbs that spared both the hands and feet.

3. A 70 year lady old collapsed at home and is taken to hospital. She regains consciousness but has a right sided hemiplegia, hemianesthesia and hemianopia with eye deviation towards the left. She also has an expressive aphasia.

4. A 70 year old man is presents with headache, being unable to read the right pages of his book and walking into a lamppost. Neurological examination revealed left sided sensory loss in the head and limbs.

5. A 70 year old lady presented with a headache, mild weakness and drowsiness. She says she can’t remember when it started. On CT the lesion is hypo-dense to the brain parenchyma.

ANSWERS

1. M

2. N

3. G

4. L

5. D

Notes: PICA occlusion is also known as lateral medullary syndrome.

Chronic sub-durals are iso-dense or hypo-dense on CT, compared to acute sub-durals which are hyper-dense.

Watershed infarcts are cortical infarcts caused by prolonged periods of low perfusion, common in patients with a history of cardiovascular disease.