A 56 year old woman is seen in her GP clinic where she reports a 7 day history of left sided back pain radiating down her left leg described as shooting in nature. She has not suffered any recent trauma. Examination reveals a positive straight leg raise but no focal neurology and no sensory deficit. She has a background of atrial fibrillation for which she is on warfarin and asthma. She has tried regular paracetamol with little improvement. What would you advise for further pain management?

A 56 year old woman is seen in her GP clinic where she reports a 7 day history of left sided back pain radiating down her left leg described as shooting in nature. She has not suffered any recent trauma. Examination reveals a positive straight leg raise but no focal neurology and no sensory deficit. She has a background of atrial fibrillation for which she is on warfarin and asthma. She has tried regular paracetamol with little improvement. What would you advise for further pain management?

A 30 year old lady presents with a three-month history of episodes of headache. The headaches can start any time of the day and last hours, with associated nausea. They resolve after the patient goes to lie down in a dark room. There are no visual changes. The headaches are occurring around once per week and are causing the patient to miss days of work. The patient is usually fit and well. She takes paracetamol when the headache occurs which doesn’t help and takes microgynon 150/30 OD. On fundoscopy you see the following (see comments of post). What is the most likely diagnosis?

A 30 year old lady presents with a three-month history of episodes of headache. The headaches can start any time of the day and last hours, with associated nausea. They resolve after the patient goes to lie down in a dark room. There are no visual changes. The headaches are occurring around once per week and are causing the patient to miss days of work. The patient is usually fit and well. She takes paracetamol when the headache occurs which doesn’t help and takes microgynon 150/30 OD. On fundoscopy you see the following (see comments of post). She reports the headache has just started now and is severe. Which of the following treatment would you prescribe?

A 30 year old lady presents with a three-month history of episodes of headache. The headaches can start any time of the day and last hours, with associated nausea. They resolve after the patient goes to lie down in a dark room. There are no visual changes. The headaches are occurring around once per week and are causing the patient to miss days of work. The patient is usually fit and well. She takes paracetamol when the headache occurs which doesn’t help and takes microgynon 150/30 OD. On fundoscopy you see the following (see comments of post). The headaches settle with once-off doses of sumatriptan although she is having to use this two-three times/week. What treatment would you start?

A 30 year old lady presents with a three-month history of episodes of headache. The headaches can start any time of the day and last hours, with associated nausea. They resolve after the patient goes to lie down in a dark room. There are no visual changes. The headaches are occurring around once per week and are causing the patient to miss days of work. The patient is usually fit and well. She takes paracetamol when the headache occurs which doesn’t help and takes microgynon 150/30 OD. On fundoscopy you see the following (see comments of post). The headaches settle with once-off doses of sumatriptan although she is having to use this two-three times/week. What treatment would you start?

A 76 year old woman is seen in A&E, where she describes a 30 minute episode of right sided facial weakness and slurred speech occurring several hours ago which has now resolved. She has a background of COPD but no other health problems. She is takes inhalers only. On examination, there is no neurological deficit, her BP is 130/85 and her ECG is unremarkable. What is her ABCD2 score and how quickly should a specialist review her?

A 76 year old woman is seen in A&E, where she describes a 30 minute episode of right sided facial weakness and slurred speech occurring several hours ago which has now resolved. She has a background of COPD but no other health problems. She is takes inhalers only. On examination, there is no neurological deficit, her BP is 130/85, and her ECG is unremarkable. Which of these would not be appropriate as part of the initial management plan?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. What would be most important to do initially after a neurological examination?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. What is the most likely underlying diagnosis?

A 68-year-old man presented with a 3-day history of progressively weak legs, and is now unable to walk. There is no numbness or tingling, no speech or swallowing problems, no visual change and no weakness of the arms. He does not recall any symptoms like this before. He says he is usually fit and well, however has chronic back pain and has had problems with urinary dysfunction for which he has been taking tamsulosin. He also thinks he has lost weight. He is a lifelong smoker. Which investigation would be most useful in establishing the diagnosis?

A 78 year old man is admitted to A&E with sudden onset of right arm and leg weakness associated with problems with his vision and speech which has been present for the last 6 hours. On examination he has flaccid weakness in both right limbs and a right sided homonymous hemianopia. He has a background of hypertension, diabetes, and ischaemic heart disease. What is the classification based on the symptoms present?

A 78 year old man is admitted to A&E with sudden onset of right arm and leg weakness associated with problems with his vision and speech which has been present for the last 6 hours. On examination he has flaccid weakness in both right limbs and a right sided homonymous hemianopia. He has a background of hypertension, diabetes, and ischaemic heart disease. Which lesion could account for his visual symptoms (see picture below)?

A 78 year old man is admitted to A&E with sudden onset of right arm and leg weakness associated with problems with his vision and speech which has been present for the last 6 hours. On examination he has flaccid weakness in both right limbs and a right sided homonymous hemianopia. He has a background of hypertension, diabetes, and ischaemic heart disease. What is the most important initial management?

A 62 year old man is brought to the admissions unit with a 3 day history of headache, confusion and abnormal behaviour. He was previously fit and well. He is found to have a temperature of 38.5⁰C and on examination he is confused but does not have any focal neurology, signs of raised intracranial pressure, or neck stiffness. What is a the most likely diagnosis?

A 62 year old man is brought to the admissions unit with a 3 day history of headache, confusion and abnormal behaviour. He was previously fit and well. He is found to have a temperature of 38.5⁰C and on examination he is confused but does not have any focal neurology, signs of raised intracranial pressure, or neck stiffness. What is the most important initial investigation?

A 62 year old man is brought to the admissions unit with a 3 day history of headache, confusion and abnormal behaviour. He was previously fit and well. He is found to have a temperature of 38.5⁰C and on examination he is confused but does not have any focal neurology, signs of raised intracranial pressure, or neck stiffness. What is the most important initial treatment?

A 60 year old man, presented with a 3 month history of progressive left leg weakness. He has type 2 diabetes mellitus but is otherwise fit and well. On examination of the lower limbs: inspection is normal, tone normal, left leg power is grade 1/5 and right leg power 5/5. On examination of the reflexes the left leg reflexes are slightly brisker than the right. On sensory examination there is reduced sensation to the coldness of the tuning fork and pin prick in the right leg. Where is the lesion?

A 60 year old man, presented with a 3 month history of progressive left leg weakness. He has type 2 diabetes mellitus but is otherwise fit and well. On examination of the lower limbs: inspection is normal, tone normal, left leg power is grade 1/5 and right leg power 5/5. On examination of the reflexes the left leg reflexes are slightly brisker than the right. On sensory examination there is reduced sensation to the coldness of the tuning fork and pin prick in the right leg. Which of these would be the most likely diagnosis?