Pathology EMQ template.

Name: Daniel Brown

Candidate number:

Theme: Cerebrovascular Disease

OPTION LIST

A	Antiphospholipid syndrome	I	Mycotic aneurysm
B	Arteriovenous malformation	J	Paradoxical embolism
C	Atrial myxoma	K
D	Berry aneurysm	L
E	Carotid dissection	M
F	Giant cell arteritis	N
G	Hyperviscosity	O
H	Left ventricular thrombus	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 33 year old previously healthy woman is admitted to hospital with a low grade fever, vasculitic lesions around her nailbeds, a harsh pansystolic murmur and bibasal crepitations. A few days after admission she is found slumped to the left with a marked left-sided weakness and facial palsy.

2. A 61year old woman presents in the A&E department with a marked left-sided weakness and dysarthria. Investigations reveal Hb 9.2, MCV 98, WCC 2.9, Plt 76, Na 134, K 5.7, Urea 22.2, Cr 512, Cca 3.08, ESR 122.

3. A 29 year old man with known adult polycytic kidney disease presents in the A&E department witha severe headache and a decreased level of consciousness. On examination he has a GCS of 6, BP 200/100 and pulse 60BPM. There is no focal neurological deficit but he has bilateral extensor plantar responses.

4. A 34 year-old woman with a previous history of several miscarriages and DVT of the lower limbs presents in A&E with a right hemiparesis and dysphasia. Routine investigations are all normal except her ESR which is 76.

5. A 61 year old man presents in teh A&E department with a left hemiparesis and a decreased level of conciousness. On examination BP 145/75, pulse 110BPM regular, midzone crepitation and mild ankle oedema. Of note he had an acute anterior myocardial infarction eight months previously and an ECG confirms persistant ST segment elevation in leads V1-V4.

ANSWERS

1. I

2.G

3. D

4.A

5. H