AMC MCQ Neurology and Mental Health 2 — Questions and Answers
Question 1: A 68-year-old presents with sudden right-sided weakness and expressive aphasia that resolves completely within 45 minutes. CT brain is normal. What is the most appropriate immediate management?
- Commence aspirin and arrange urgent specialist assessment (Correct answer)
- Reassure and discharge as symptoms resolved
- Commence warfarin immediately
- Repeat CT in 24 hours only
Correct answer: Commence aspirin and arrange urgent specialist assessment
A resolving focal deficit is a transient ischaemic attack, requiring antiplatelet therapy and urgent assessment to prevent stroke.
Question 2: A 24-year-old woman reports recurrent episodes of intense fear, palpitations, sweating and a sense of impending doom lasting about 10 minutes, with no medical cause found. What is the most likely diagnosis?
- Panic disorder (Correct answer)
- Generalised anxiety disorder
- Phaeochromocytoma
- Hyperthyroidism
Correct answer: Panic disorder
Recurrent discrete episodes of intense fear peaking within minutes, with no organic cause, characterise panic disorder.
Question 3: A patient with Parkinson's disease develops worsening tremor and rigidity after being started on a new medication for nausea. Which drug is the most likely cause?
- Metoclopramide (Correct answer)
- Ondansetron
- Domperidone
- Cyclizine
Correct answer: Metoclopramide
Metoclopramide is a central dopamine antagonist that crosses the blood-brain barrier and worsens parkinsonism.
Question 4: A 30-year-old man with schizophrenia on haloperidol develops fever, muscle rigidity, autonomic instability and a markedly raised creatine kinase. What is the diagnosis?
- Neuroleptic malignant syndrome (Correct answer)
- Serotonin syndrome
- Malignant hyperthermia
- Acute dystonia
Correct answer: Neuroleptic malignant syndrome
Fever, rigidity, autonomic instability and raised CK in a patient on antipsychotics indicate neuroleptic malignant syndrome.
Question 5: A 55-year-old presents with the 'worst headache of my life' that began suddenly. CT brain is normal at 12 hours. What is the next most appropriate investigation?
- Lumbar puncture looking for xanthochromia (Correct answer)
- Reassure and discharge
- MRI of the lumbar spine
- EEG
Correct answer: Lumbar puncture looking for xanthochromia
A thunderclap headache with a normal CT requires lumbar puncture to detect xanthochromia from subarachnoid haemorrhage.
Question 6: A 40-year-old woman reports two weeks of persistent low mood, anhedonia, early morning waking, poor appetite and thoughts that life is not worth living. What is the most appropriate first action?
- Assess suicide risk in detail (Correct answer)
- Prescribe a hypnotic and review in a month
- Refer for dietary advice
- Recommend increased exercise only
Correct answer: Assess suicide risk in detail
Any disclosure of thoughts that life is not worth living mandates a detailed suicide risk assessment.
Question 7: A 70-year-old man has a resting tremor, bradykinesia and cogwheel rigidity that began on one side. What is the most likely diagnosis?
- Idiopathic Parkinson's disease (Correct answer)
- Essential tremor
- Cerebellar tremor
- Benign physiological tremor
Correct answer: Idiopathic Parkinson's disease
Asymmetric resting tremor with bradykinesia and rigidity is the classic triad of idiopathic Parkinson's disease.
AMC MCQ Neurology and Mental Health 2
A 68-year-old presents with sudden right-sided weakness and expressive aphasia that resolves completely within 45 minutes.
CT brain is normal.
What is the most appropriate immediate management?