Pathology EMQ template.

Name: Karl Casey

Candidate number: 00467405

Theme: Cerebrovascular Disease

OPTION LIST

A	Watershed cerebral infarction	I	Atrial fibrillation, smoking, diabetes
B	Left MCA	J	Internal Capsule (Anterior limb)
C	PCA	K	Hypertension, smoking, diabetes
D	Alcohol, smoking, diabetes	L	Basilar Artery
E	Internal Capsule (Posterior limb)	M	Hypertensive encephalopathy
F	Infarction of the visual cortex	N	Right MCA
G	Internal carotid artery	O	Frontal lobe syndrome
H	Smoking, diabetes, obesity	P	ACA

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 90 year old World War II veteran is brought into hospital by his son. He normally gets out of bed on his own but this morning he was bed bound. His son observed that he was unable to use his left arm or leg, his face looked a 'bit funny' and that he was slurring his speech. What is the most likely site of this infarct?

2. A 60 year old woman is brought to A&E by ambulance. She is unable to answer questions and on examination her right arm has reduced power and her face is asymmetrical. Where is the most likely site of this infarct?

3. Prudent Peter calls into your GP surgery for his weekly visit late on Friday evening. He reports having read in the "Daily Express", off which he ate his dinner that day, that there were important steps the public could take to reduce their chances of having a stroke. Initially startled at the unprecedented accuracy of the newspaper in question, you proceed to tell Peter the three most important modifiable risk factors for stroke.

4. You are a neuro Spr called to see an 83 year old woman on MAU recovering from a massive MI she got after getting spear tackled by her son-in-law during a friendly game of rugby the previous afternoon. Having previously been compos mentis the patient is now intellectually impaired, with memory loss and cortical visual impairment. Given the borderzone infarcts on CT what is the most likely diagnosis?

5. A 65 year old Asian lady presents to A&E with left unilateral limb dyspraxia. Your supervising Spr tells you this is a rare presentation and asks you to work out where the most likely site of this lady's infarct is.

ANSWERS

1. E

2. B

3. K

4. A

5. P