A 75 year old man is reviewed in his GP surgery because his wife things he has become more forgetful over the past few months. He is found to have significant cognitive impairment. Which of the following is least useful before making a diagnosis of dementia?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. Shoulder abduction is 1/5 bilaterally and finger extension 4/5. Hip flexion is 1/5 bilaterally and foot dorsiflexion and plantarflexion is 4/5. Given the likely diagnosis, what is the pattern of weakness and where would you localise the lesion to?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. There is a proximal pattern of weakness bilaterally. Reflexes are normal. Which of the following investigations would give you a definitive diagnosis?

63F presents with a two week history of progressive weakness and dysphagia. There is no diurnal variation. On examination she has a violaceous rash over the eyelids and papules over the knuckles. Tone is normal. There is a proximal pattern of weakness bilaterally. Reflexes are normal. A muscle biopsy has been sent off, with your working diagnosis of dermatomyositis. What additional investigation should you consider at this stage?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. Where would you localise the lesion?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. What is the most important investigation to confirm the likely diagnosis?

A 35 year old woman presents with a band-like sensation around her abdomen, leg weakness and bladder dysfunction. On questioning she reveals that she had an episode around a year ago, where she experienced left eye pain and problems with her vision, this resolved within a few weeks and she did not seek medical attention. On examination she has increased tone in her legs, bilateral weakness and hyperreflexia. What is/are the key factor(s) required to make a diagnosis of multiple sclerosis?

A 76 year old man attends clinic with reduced mobility for the last 3 months. As he walks into the clinic room, you see he has the following gait (see video in comments). Which of the following clinical features would you be most likely to find?

A 76 year old man attends clinic with reduced mobility for the last 3 months. As he walks into the clinic room, you see he has a shuffling gait with reduced arm swing. On examination, there is rigidity, more so in the left upper limb than the right. There is no tremor but you think there is bradykinesia. He is on a long list of medication and you are not sure if they might be causing some of the symptoms. Which of the following investigations could you use to support the likely diagnosis?

You do a DAT scan which appears like this (see post comments) and diagnose the patient with Parkinson's disease. Which of the following is a medication that can be used to treat motor symptoms in Parkinson's disease?

A 60 year old gentleman is admitted to the medical assessment unit with a headache, fever and confusion for the last few hours. He had no past medical history of note. On examination, he has neck stiffness but no focal neurological signs and no evidence of rash. He is GCS 15/15. What is the most important initial investigation?

A 60 year old gentleman is admitted to the medical assessment unit with a headache, fever and confusion for the last few hours. He had no past medical history of note. On examination, he has neck stiffness but no focal neurological signs and no evidence of rash. He is GCS 15/15. The CSF results as follows. What is the diagnosis?

A 60 year old gentleman is admitted to the medical assessment unit with a headache, fever and confusion for the last few hours. He had no past medical history of note. On examination, he has neck stiffness but no focal neurological signs and no evidence of rash. He is GCS 15/15. Which of these is most important in the management of this patient in addition to antibiotics?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The rest of the examination is unremarkable. What is the likely diagnosis?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The rest of the examination is unremarkable. Following your assessment, which initial investigation should be carried out?

A 75-year-old right handed lady presents having woken at 7am with new onset speech disturbance and right-sided weakness. She was last seen well before going to bed at 10pm the night before. She has a past medical history of hypertension and hypothyroidism. You complete an ABCDE assessment and an ECG shows an irregularly irregular rhythm at a rate of 75bpm. On examination, right upper and lower limb power is 3/5 and she is unable to name objects. The CT brain is reported as NAD however the patient’s symptoms are ongoing. Which of the following treatments should be commenced?

A 19 year old woman is admitted to A&E with a history of sudden collapse, loss of consciousness, and rhythmic shaking of her arms and legs. The episode has lasted about 15 minutes. She had been on a night out with her friends drinking alcohol and had been otherwise well previously. What is the most appropriate first line treatment?

A 19 year old woman is admitted to A&E with a history of sudden collapse, loss of consciousness, and rhythmic shaking of her arms and legs. The episode has lasted about 15 minutes. She had been on a night out with her friends drinking alcohol and had been otherwise well previously. Investigations have not revealed any structural cause of seizures and she is back to her baseline. What treatment does she need going forward?

A 19 year old woman is admitted to A&E with a history of sudden collapse, loss of consciousness, and rhythmic shaking of her arms and legs. The episode has lasted about 15 minutes. She had been on a night out with her friends drinking alcohol and had been otherwise well previously. She has been treated acutely for her seizure and is due for discharge. What advice does she need regarding driving?