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Which of these is NOT a contraindication to thrombolysis in acute stroke?

A 58 year old man attends clinic with his wife. His wife describes three episodes in the past three weeks during which the patient has had ‘twisting of the right side of his face, followed by stiffening for his right arm before he collapses to the ground jerking.’ The episodes last two minutes and then it is 30 minutes until he is back to his normal self. Examination is unremarkable. What is the single most appropriate investigation to arrange?

A 70 year old woman presents with a four-month history of malaise, night sweats and aches in her shoulders and hips. More recently, she has noticed a headache, more marked on the left than right, with blurring of her vision. What is the most appropriate management?

A 35 year old woman presents to her GP with a several month history of pounding headache which is at its worst in the morning. She also reports feeling nauseated. She has a background of asthma and has a BMI of 35. Neurological examination but fundoscopy shows swelling of the optic disc. Brain imaging is unremarkable and LP shows raised opening pressure but is otherwise normal. Given the likely diagnosis what is the most appropriate treatment?

A 75-year-old woman presents with difficulty seeing out of her left eye and a tendency to bump into objects on that side. She woke with her symptoms yesterday morning but is otherwise well. Examination shows a left homonymous hemianopia and visual field testing shows macular sparing. Where is the lesion most likely to be?

A 75 year old man with known idiopathic Parkinson's disease is reviewed in an outpatient clinic. Which of the following is not a known complication of Parkinson's disease?

A 23-year old woman was brought to the emergency department unconscious. On examination, her temperature was 38ºC, and pulse and blood pressure were normal. The Glasgow Coma Score was 7, she had neck stiffness but there were no focal neurological signs. What is the most useful initial investigation?

A 60 year old man presents to a neurology outpatient clinic with history of difficulty walking and falls for a few months. On examination, he has some atrophy of the thigh muscles, reduced power of foot dorsiflexion bilaterally right > left and upgoing plantar reflexes bilaterally. Sensation is normal throughout. What is the most likely diagnosis?

Which of the following best describes the signs seen in a CNIII (oculomotor) palsy?

You review a 75 year old man on a home visit with the GP. He reports feeling unsteady and nauseous for the past couple of days. On examination, he has slurred speech. Tone, power and reflexes are normal but he has difficulty with coordination on the left and a broad based unsteady gait. What is the likely site of the lesion?

A 65-year-old man presents complaining of brief episodes of dizziness, lasting less than a minute each time. He finds it seems to be worse when he turns his head to one side and is often associated with nausea and vomiting. Which would be the most appropriate management?

A 50 year old farmer is admitted with a history of bilateral leg weakness that has been progressively ascending for the past week. He reports a bout of diarrhoea around 2-3 weeks ago. Given the likely diagnosis what additional feature is least likely?

A 48 year old man presents with a 6 month history of progressive weakness affecting his arms and legs. More recently he has started to notice his speech is slurred. On examination he has weakness throughout upper and lower limbs with muscle wasting and dysarthria. Which would be the most useful investigation to aid in making a diagnosis?

You review a 19 year old man in a neurology outpatient clinic. He is known to have epilepsy with generalised tonic-clonic seizures. Recently he has noticed he is having seizures more frequently. Which of the following is least helpful in evaluating his increased seizure frequency?

A 70 year old lady attends clinic with her daughter. The daughter is concerned that her mother has been increasingly confused and sometimes acts as if she can see someone in the garden when there is no-one there. The symptoms fluctuate. On examination gait is slow and there is increased tone in the upper limbs. What is the likely cause of confusion?

You are on your GP placement and the next patient on the list has booked an appointment due to back pain. You have been asked to take a history and perform an examination. Which of the following are not a ‘red flag’ for back pain?

A patient presents with sensory disturbance in the legs and weakness. On sensory examination, you find on the left lower limb he has reduced sensation to fine touch, vibration and proprioception and on the right lower limb he has reduced sensation to pain and temperature. How would you localise the lesion?

You are asked to review a 70 year old gentleman who has recently been admitted to hospital generally unwell and is being treated for a UTI. His daughter tells you over the past few days he has been intermittently confused particularly at night and on a couple of occasions appeared to see people who weren't there. What is the most likely cause for his confusion?

Which of these clinical presentations is the LEAST characteristic of an essential tremor?

You are asked to review a Chris Cringle a 65 year old gentleman who reports a several month history of numbness and tingling sensations in his lower legs. On examination he has a bilateral distal sensory loss to fine touch and pin prick sensation but a normal motor examination. Which of these is least likely to be a cause of his presentation?