ASN Web Quiz - Association of Sri Lankan Neurologists (ASN)

ASN Quiz League 2023/24 Q4

Past Quizzes

ASN Quiz League 2023/24

ASN Quiz League 2023/24 Q3

An elderly man was recently evaluated for exertional fatigue and underwent exercise ECG testing. He was started on dual anti-platelet therapy for presumed ischaemic heart disease. On the following day, he developed a rapid onset, severe and progressive headache with near complete left sided ptosis and mydriasis. He also had a severe hypotensive episode with deterioration in GCS score. Imaging was performed. MRA ruled out an aneurysm and plain CT did not show haemorrhage within the cerebral cortex nor the brain stem. With the imaging, he was diagnosed to have a neurosurgical emergency and underwent an urgent neurosurgical intervention which rapidly reversed the problems. Image A - past MRI brain. Image B - current MRI brain.

IMAGE

A1) What is the ‘neurosurgical emergency’ diagnosed in this patient? *

A2) What is the other common presenting neurological dysfunction in this emergency? *

A3) What dedicated imaging modality provides exact details on this diagnosis? *

A4) What is the other diagnosis/already present lesion, predisposing this patient to this emergency? *

B1) What other specialist services are necessary to expertly manage this emergency? *

B2) What immediate therapeutic measures would you perform before proceeding to urgent neurosurgery? *

C1) After the neurosurgical procedure what are the possible complications you would expect? *

C2) State therapeutic options to prevent/manage these problems. *

C3) One therapeutic option has to be performed very gradually. State a neurological complication that is prevented by adopting such a careful approach. *

Name *

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ASN Quiz League 2023/24 Q2

A man complains to his family doctor that his wife is not smiling at him despite a warm attitude and behaviour. He also sees her crying on and off and noticed that her voice has also changed. He is perplexed at this and brings her in for a checkup. History and examination reveals that his wife tries to smile, but cannot. On questioning, she mentions that 2 weeks ago she had a febrile illness but had recovered. They happen to live in a rural area with dense shrubbery and sleep on the floor of their house.

A1) Which neurological clinical phenomenon could explain all these symptoms? *

A2) What are the additional clinical signs that must be demonstrated to confirm the above? *

B1) What is the neurological emergency that could present with these symptoms? *

B2) What is the clinical examination instrument that helps to support or rule out this emergency? *

B3) What are the clinical signs that the instrument can elicit with regard to the above? *

C1) What other medical emergency could also cause A1, in the context of their living arrangements and a hyper-acute presentation? *

C2) What are the infective causes for A1? *

C3) What are the non-infective causes for A1? *

D1) Several months later, the patient above complains of shedding tears involuntarily while eating and drinking. Name the clinical syndrome. *

D2) What is the popular name given to these tears in the English language? *

D3) Briefly explain the pathophysiology of this syndrome. *

Name *

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ASN Quiz League 2023/24 Q1

Vesak is a day of significance for all Buddhists, rekindling spirituality and pilgrimage. The photo shows a sacred place of worship in Sri Lanka, as seen from Colombo. It is frequented by thousands of pilgrims of many faiths. Recently, based on the unfortunate death of a person who had visited the site, concerns were raised that an outbreak of an infectious disease might be spreading among pilgrims.

Image

A1) List 3 names given to this sacred place. *

B1) What is the neurological disorder that was identified as the cause of death? *

B2) What was the aetiological agent that caused the disease? (Give the scientific name) *

B3) Which neuroanatomic structure is classically affected by this agent? *

C1) What are the investigation results that confirm the agent as the cause? (Give the method and characteristic feature) *

C2) The usual choice of broad spectrum antibiotics for this disorder are to be avoided when treating this agent. Give the class of antibiotic to be avoided and state why. *

D1) List three patient groups that are especially vulnerable to this agent. *

D2) List three preventive strategies to protect pilgrims from this agent. *

Name *

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2023

31 March 2023

The seeds of the legume shown above contain an important bioactive chemical useful in the treatment of a neurological disorder. The two actors shown on the right were casted to a film based on a book about the disorder written by the neurologist pictured in the center.

Image

A1) What is the neurological disorder? *

A2) Identify the plant by its scientific name. *

A3) Give one name each for the plant in the languages of Sinhala and Tamil. *

B1) What is the relevant bioactive chemical contained within the plant? *

B2) What is the chemical process that affects the bioavailability of this chemical within the CNS? *

B3) How is the above mitigated in pharmaceutical preparations of the bioactive chemical? *

B4) List two early side-effects that cause poor tolerance when the above method of mitigation is used. *

C1) Name the specific side-effect that occurs in the long term use of the bioactive chemical. *

C2) What is the non-pharmacological intervention to minimize this side-effect? *

Name *

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10 March 2023

Answer in fields below.

A) What is the descriptive anatomic term given for the highlighted portion of the human brain? *

B1) Name the blood vessel that supplies the above cerebral lobe. *

B2) Early NCCT scans reveal a distinct radiological sign when the above cerebral lobe is affected by acute ischaemic stroke. Name the sign. *

B3) Explain why the above radiological sign appears first in the timeline of radiological findings. *

C1) The semiology of seizures originating from the highlighted lobe has earned it another descriptive name. Name it. *

C2) Despite the descriptive name, the semiology may have certain characteristic symptoms. Name two of such symptoms. *

C2) A rare and worst-possible complication of epilepsy is postulated to involve epilepsy originating from the highlighted lobe. Name the complication. *

Name *

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10 February 2023

The 16th Annual Congress of the Association of Sri Lankan Neurologists (ASNAC) is just around the corner, with an academic programme spanning four days, including a Masterclass on Headache, a Pre-congress on Movement Disorders, a two day Congress, and a Post-congress workshop on Epilepsy Surgery. This week’s quiz is about the history of Neurology in Sri Lanka with a bonus prize of a free delegate pass to ASNAC!

Answer in fields below.

A) Name the Neurologist who founded the Institute of Neurology of the National Hospital of Sri Lanka. *

B) Name the Founder President of ASN. *

C) Name the first Clinical Neurophysiologist of Sri Lanka. *

D) Name four national organizations that contribute to the development of neurological services; neurology research; and neurological disease advocacy in Sri Lanka. *

Name *

Email *

Name

13 January 2023

11 November 2022

Weekly Quiz - 29 August 2021

A middle aged female with a long history of epilepsy was stable on carbamazepine 400mg thrice daily. She did not have seizures for many years and has discontinued her medications and follow up due to the COVID 19 pandemic. She recently had the first dose of her COVID 19 vaccine too. She was admitted to the Emergency unit with recurrent seizures. She had fractured her wrist and also had bruises. She was immediately restarted on her medications as per the clinic book. The next day she was found deteriorating with vomiting, severe vertigo and progressive drowsiness. The basic examination and bloods ruled out any sepsis or overt infections. QUESTION 1 OF 4 (A) : What is the most probable cause for her deterioration? *

QUESTION 1 OF 4 (B) : What other blood test could help explain another possible cause for the drowsiness in this context? *

QUESTION 1 OF 4 (C) : What changes could be done in the management for a better clinical outcome? *

QUESTION 2 OF 4 (A): What are the medications best used for acute seizure control? *

QUESTION 2 OF 4 (B): State the IV medications available in Sri Lanka for acute seizure control. *

QUESTION 3 OF 4 : How would you avoid epilepsy patients defaulting treatment in these COVID 19 pandemic times? *

QUESTION 4 OF 4 : She is due for her second COVID 19 vaccine. She fears that it’s a contraindication as she had had seizures after the first dose. What will be your answer/advice? *

Name *

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Weekly Quiz - 14 August 2021

QUESTION 1 OF 4 (A) : Name the eponymous bedside clinical sign described in the nineteenth century that tests stance/balance. *

QUESTION 1 OF 4 (B) : Describe how to test this. *

QUESTION 1 OF 4 (C) : What neurological system is being tested in 1B? *

QUESTION 2 OF 4 (A): Name your clinical conclusion when this sign is positive but routine peripheral nerve conduction studies are found to be normal. *

QUESTION 2 OF 4 (B): Name an infection and a deficiency state that could theoretically cause the condition in 2a. *

QUESTION 3 OF 4 : Name two more major neurological systems (other than 1c) involved in stance/balance. *

QUESTION 4 OF 4 (A): The Neurologist who described this eponym is also described as ‘The first clinical Neurologist'. However, he may not have been aware of or had not mentioned one of the systems mentioned in Q3. Name this system. *

QUESTION 4 OF 4 (B): Name some clinical tests/examinations to test the system mentioned in 4A. *

Name *

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Weekly Quiz - 01 August 2021

A 17 year old boy was brought to Neurology clinic for dropping things over the past six months. He has dropped cups when having his favorite bed tea, plates while walking just out of his room, pens while looking at the computer screen and his mobile phone while playing video games. The image shows a specific investigation done on him.

QUESTION 1 OF 4 (A) : Name this investigation (need a complete answer). *

QUESTION 1 OF 4 (B) :Name the finding on the investigation. *

QUESTION 2 OF 4 (A): What could be the most probable diagnosis? *

QUESTION 2 OF 4 (B): What treatment option has the greatest evidence for this diagnosis? *

QUESTION 2 OF 4 (C): Name another accepted treatment option for this diagnosis which however can paradoxically exacerbate the above mentioned symptoms. *

QUESTION 3 OF 4 : State three other vital advices for this boy to prevent the above mentioned problems. *

QUESTION 4 OF 4 (A): On careful history it was found that he was a bright student in his childhood, but during the last few years he has lost concentration in the class and at times has left few words unanswered in dictation tests. How would you explain this? *

QUESTION 4 OF 4 (B): If he had a similar investigation (to what is shown) then what abnormality will you look for in it? *

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Weekly Quiz - 23 July 2021

The image shows a doctor examining a patient before the discovery of the stethoscope. Subsequently, the stethoscope revolutionized physical examination and is established as a tool signifying a doctor and what he does.

QUESTION 1 OF 4 : Name the equivalent tool that is valuable and signifies the practice of ‘Clinical Neurology’. *

QUESTION 2 OF 4 (A): Name the four major components of a doctor’s physical examination. *

QUESTION 2 OF 4 (B): For which component of 2A is the above tool useful? *

QUESTION 2 OF 4 (C): What physiological phenomenon/phenomena is examined (assessed) by this tool? *

QUESTION 3 OF 4 (A): Neurological disorders can be categorized/differentiated by eliciting abnormalities in the phenomenon/phenomena mentioned in 2C by the above tool. A) Name the two major categories of neurological disorders that could be differentiated by this tool. *

QUESTION 3 OF 4 (B): Name a special maneuver which is used when the phenomenon in 2C is not elicitable by the above tool. *

QUESTION 3 OF 4 (C): Name a neurological emergency where the phenomenon/phenomena in 2C will not be elicitable even with the maneuver in 3B. *

QUESTION 4 OF 4 (A): This tool has been historically used for non-neurological disorders as well, both in Sri Lanka and around the world. A)How will it be useful to assess the adequacy of treatment of a hypothyroid patient in a setting where TSH assays are not readily available? *

QUESTION 4 OF 4 (B): In the 18th and early 19th centuries an earlier version of this tool was first developed and used for a non-neurological examination. Name the earlier version of this tool and its non-neurological use/uses. *

Name *

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Weekly Quiz - 16 July 2021

Weekly Quiz - 09 July 2021

Due to the pandemic restrictions, a patient had to consult his doctor remotely by the phone. The doctor diagnosed a Bell’s palsy and requested a photo for confirmation. On seeing the photo sent to his WhatsApp he ordered an investigation . The selfie sent by the patient and an image of the investigation are given here. The patient did not have any other comorbidities.

Photo
Investigation

QUESTION 1 OF 3 (A): What treatment has the strongest evidence for improving this palsy in this patient? *

QUESTION 1 OF 3 (B): State a communicable and a non-communicable causation mostly speculated to be linked to the clinical presentation above. *

QUESTION 2 OF 3 (A): What additional questions should the doctor be asking for the complete management of this patient? *

QUESTION 2 OF 3 (B): If the patient comes for a physical examination, what other neurological systems should be examined other than the adjacent cranial nerves? *

QUESTION 3 OF 3 (A): The patient inquired about the following from the doctor: What will be your responses? - Do I need surgery for my palsy? *

QUESTION 3 OF 3 (B): "How to care for my tearing eye?" *

QUESTION 3 OF 3 (C): Is there a place for botulinum toxin injections for this weakness ? *

Name *

Email *

Name

Weekly Quiz - 27 June 2021

Magnetic Resonance Imaging (MRI) has revolutionized diagnostic imaging in neurology. However, due diligence is necessary when requesting for it.

QUESTION 1 OF 4 (A): Name the two main sequences of MR imaging based on relaxation times. *

QUESTION 1 OF 4 (B): What feature on MRI films is useful to differentiate (correctly identify) between the above sequences? *

QUESTION 2 OF 4 (A): What is usually used as a contrast agent in MR imaging? *

QUESTION 2 OF 4 (B): Name the medical status/illness you must rule out before the administration of 2a. (indicate the relevant investigation) *

QUESTION 2 OF 4 (C): What is the rare but significant complication that is prevented by ruling out the above? *

QUESTION 3 OF 4 (A): There are specific MRI techniques/sequences that need to be requested for specific clinical scenarios. Name the technique used for each scenario given below. A. Acute ischaemic stroke *

QUESTION 3 OF 4 (B): CNS vasculitis *

QUESTION 3 OF 4 (C): Cerebral venous thrombosis *

QUESTION 3 OF 4 (D): Cerebral micro bleeds *

QUESTION 4 OF 4: Name the two special imaging techniques shown in images A & B. *

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Weekly Quiz - 20 June 2021

These images show a characteristic radiological sign but only recently described in COVID-19 encephalitis.

QUESTION 1 OF 3 (A): Name the structure indicated by the arrows. *

QUESTION 1 OF 3 (B): Name this radiological sign. (clue: the sign is named after the structure in 1A) *

QUESTION 2 OF 3 (A): This sign was previously noted in para-infectious autoimmune encephalitic syndromes. Name a paediatric epilepsy syndrome with this characteristic radiological sign. *

QUESTION 2 OF 3 (B): Name the ‘neurological emergency’ at the start of this epileptic syndrome. *

QUESTION 3 OF 3 (A): Name the commonest neurological complication due to COVID-19 that can be diagnosed by MRI. *

QUESTION 3 OF 3 (B): Name the commonest systemic insult due to COVID-19 that could cause neurological sequela. *

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Weekly Quiz - 11 June 2021

These images show insults to different parts of a pair of vital organs .

QUESTION 1 OF 3 : Amidst controversy, a physician is credited for giving the widely accepted medical term for this organ. Name this physician. *

QUESTION 2 OF 3 (A): Describe the syndrome ‘named after’ this organ. *

QUESTION 2 OF 3 (B): Which image or images show compatible insults that could cause this syndrome? *

QUESTION 2 OF 3 (C): Name this imaging modality. *

QUESTION 3 OF 3 (A): There are some rare neurological states that could specifically damage these bilateral organs concurrently. Name a salient cause/causes appropriate for each of the following scenarios. A single blood vessel (artery) which could cause this. *

QUESTION 3 OF 3 (B): Two genetic causes. *

QUESTION 3 OF 3 (C): A deficiency state in adults. *

QUESTION 3 OF 3 (D):Two viral infections : one caused epidemics in the last century in Sri Lanka and the other is a common cause of worldwide encephalitides but was first reported in Sri Lanka in 2015. *

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Weekly Quiz - 05 June 2021

QUESTION 1 OF 4 : The month of June is internationally dedicated for the awareness of a particular neurological problem/state. Name it. *

QUESTION 2 OF 4 (A):A famous English writer who had this particular problem had described some of its features as experienced by the little heroine of his famous book. Name the author and his book's heroine. *

QUESTION 2 OF 4 (B): State the syndrome named after this heroine and describe its main symptoms. *

QUESTION 3 OF 4 (A): Name the group of medications which are considered as specific therapy (and act on the responsible pathophysiological mechanism) to abort acute episodes of this problem. *

QUESTION 3 OF 4 (B): Name two medications that are usually available (one at the state sector and another at the private sector) in Sri Lanka, belonging to the group mentioned in 3a. *

QUESTION 4 OF 4 : Name the ‘group of medications’ which are the latest ‘evidence and pathophysiology based’ preventive treatment for this neurological problem. *

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Weekly Quiz - 28 May 2021

This week is special with Vesak being its highlight. Consciousness and Meditation are topics of intense interest and research in both Buddhism and Neurology. This quiz is based on an important tool in this search.

Figure 1
EEG 1
EEG 2

QUESTION 1 OF 4 (A): What wave pattern is usually prominent in EEG in both meditation and in the relaxed and calm state? *

QUESTION 1 OF 4 (B): State an artifact/s in the frontal channels that help to decide if a patient is awake. *

QUESTION 2 OF 4 (A): Figure 1 is usually seen in most of the EEG sheets/records. Name this system. *

QUESTION 2 OF 4 (B): State 5 important facts you should mention when requesting for an EEG. *

QUESTION 3 OF 4 (A): State two widely used activation procedures in EEG recording. *

QUESTION 3 OF 4 (B): State one characteristic EEG pattern pointing towards a particular diagnosis in children or adolescents, brought by each procedure you mentioned in 3a. *

QUESTION 4 OF 4 (A): The following two EEGs are from 2 unconscious patients (without clinical seizures) in ICU. No clinical history is provided. State the salient EEG finding and most relevant diagnosis for each one. *

QUESTION 4 OF 4 (B): What’s the gold standard investigation for difficult to diagnose ‘Psychological Non Epileptic Seizures’? *

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Weekly Quiz - 22 May 2021

In 2018, a female of 35 years of age presented with severe fatigue especially after activity, dyspnoea, myalgia, slowness, orthostatic and cognitive symptoms for the past six months. Her basic examination including neurology , basic bloods , neuro and other imaging studies were all normal. There were no muscular tender points on examination. QUESTION 1 OF 4 (A): State a possible syndromic diagnosis. *

QUESTION 1 OF 4 (B): State another widely accepted terminology for the same syndrome. *

QUESTION 2 OF 4 (A): Name a bacterial and viral infection which have the highest speculations as possible aetiologies. *

QUESTION 2 OF 4 (B): Name three non infective predisposing factors for the same sequelae. *

QUESTION 3 OF 4 (A): Name the most probable serology that could be tested in this patient if this occurred now in 2021. *

QUESTION 3 OF 4 (B): Name the syndromic diagnosis for what you mentioned in 3a. *

QUESTION 4 OF 4: What is the best preventive strategy to avoid neurological complications due to the said cause in 3a as per the currently available information. *

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Weekly Quiz - 14 May 2021

In May 2021, a man was discharged from hospital after recovering from a critical illness, he also had a long standing medical illness. The day after discharge, he presented with diplopia and headache (image A) with rapid worsening of the clinical state (image B). Based on the examination findings, a worrisome working diagnosis was made and an urgent CT brain scan was done to confirm it (image C). The past medial history and the rapid deterioration of the patient prompted suspicion of an aetiological diagnosis, and a buccal examination was done, which revealed a positive finding and the collected sample was inspected under microscopy (image D).

Images

QUESTION 1 OF 4 (A): Describe the salient clinical features in images A and B. *

QUESTION 1 OF 4 (B): Describe the salient finding in image C. *

QUESTION 1 OF 4 (C): Based on the clinical and radiological findings, what is the diagnosis? *

QUESTION 2 OF 4 (A): What is the positive finding to look for in the buccal examination? *

QUESTION 2 OF 4 (B): What is the suspected aetiological diagnosis? *

QUESTION 2 OF 4 (C): What are the characteristic features in image D to confirm the suspected aetiology? *

QUESTION 3 OF 4: State 2 factors which could have predisposed this patient to this aetiological diagnosis. *

QUESTION 4 OF 4 (A): State up to 4 therapeutic options for this patient. *

QUESTION 4 OF 4 (B): What specialist(s) is/are necessary to be consulted for optimal management, considering the aetiology? *

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Weekly Quiz - 7 May 2021

In late March 2021, a lady residing in Colombo was being managed for unstable angina in an ETU. As she was noted to have renal impairment, LMW heparin was replaced with another drug. On the third day of illness she had a fever with headache which was followed by a seizure. Her platelet count was 20,000 and a CT brain scan was done. Upon seeing the CT scan a diagnosis was made and three aetiological differential diagnoses were considered by the ETU team based on patient demographics and time situation.

CT Brain

QUESTION 1 OF 5: For the 1st aetiological DDx, the patient history was used. What timely question would have been asked from the patient? *

QUESTION 2 OF 5: For the 2nd aetiological DDx, the drug chart was used. What drug could have been implicated? *

QUESTION 3 OF 5: For the 3rd aetiological DDx, a blood test was ordered. What would have been the investigation and its expected finding? *

QUESTION 4 OF 5: Name the 3 possible aetiological DDx the ETU team was considering. *

QUESTION 5 OF 5: State up to 3 therapeutic options for this particular patient. *

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Weekly Quiz - 30 April 2021

Weekly Quiz - 23 April 2021

Weekly Quiz - 9 April 2021

Weekly Quiz - 29 January 2021

The images show the brain scans of a patient with a neurological emergency. The first two scans were taken on admission and the last two were taken 24 hours after treatment. There was significant clinical improvement on day two.

Image 1
Image 2
Image 3
Image 4

QUESTION 1 OF 4 (A): Name the neurological emergency. *

QUESTION 1 OF 4 (B): Name the score derived from the imaging modality used in this patient which, is used to prognosticate the functional outcome following the effects of this emergency. *

QUESTION 2 OF 4 (A): Name the most likely treatment administered to this patient. *

QUESTION 2 OF 4 (B): Name 3 groups of landmark clinical trials which provides evidence for the treatment above. *

QUESTION 3 OF 4 (A): Which salient factor in the patient history, especially in Sri Lankan context, is absolutely vital to proceed or withhold the treatment above. *

QUESTION 3 OF 4 (B): In advanced centres this treatment can be provided without the salient information mentioned above. Name 2 investigations that could help in such a situation. *

QUESTION 3 OF 4 (C): Name the 2 latest clinical trials that provide evidence for the advanced practice mentioned above, beyond the usual limitations of this treatment. *

QUESTION 4 OF 4: Name the other evidence-based treatment/intervention for this emergency and name a Sri Lankan public sector hospital that is equipped for it. *

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Weekly Quiz - 22 January 2021

The human brain is an amazing organ with myriad functions and abilities. Its dysfunctions or ‘neurological case histories’ make for fascinating stories in the likes of fiction and mystery thrillers. The image shows the cover of a book published by a famous Neurologist/Author. ‘The Man Who Mistook His Wife for a Hat’ is one of the case histories described in this book.

Image

Name the terminologies for the following Neurological problems in people with intact sense organs and insight.

See below

QUESTION 1 OF 4 (A): Inability to recognize familiar objects or voices. *

QUESTION 1 OF 4 (B): The inability to perceive the inability mentioned above. *

QUESTION 2 OF 4: Sometimes people could have inability to recognize familiar faces. Name this symptom. *

QUESTION 3 OF 4: Instead of non-recognition, at times patients can misidentify someone as another. Name this eponymous syndrome. *

Another book written by the same author was adopted to a drama film which received three Academy Award nominations. The storyline narrates an epidemic which caused a lasting neurological illness and a miracle medicine which treated it. This medication is commonly prescribed now.

See below

QUESTION 4 OF 4 (A): Name the book. *

QUESTION 4 OF 4 (B): What were the neurological sequelae of the epidemic mentioned above? *

QUESTION 4 OF 4 (C): Name the miracle medicine. *

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Weekly Quiz - 15 January 2021

The cultural festival called ‘Pongal’ is dedicated to Surya (Sun). Today’s quiz is based on sunlight! The image shows a sunlit day in the Royal Botanic Gardens, Peradeniya, with regular rows of trees and their shadows. A schoolgirl had fainted when she had been looking through a car window as the car sped past the pathway shown in the image. She did not have a headache and was otherwise healthy with a normal physical examination.

Image

QUESTION 1 OF 3 (A): What specific neurological episode could have been triggered by sunlight to cause her to faint? *

QUESTION 1 OF 3 (B): State the specific neurological investigation (with the particular activation procedure) you would request to confirm your suspicion. *

The same phenomena triggering the above episode can be self-induced by children using sunlight. This is part of a syndrome.

See below

QUESTION 2 OF 3 (A): Name the phenomena. *

QUESTION 2 OF 3 (B): Name the syndrome. *

It is proven that a component of sunlight is a protective factor against a major neurological illness. The International Conference in Sri Lanka with regard to research into this illness is set to take place this weekend (16-17 January 2021).

See below

QUESTION 3 OF 3 (A): Name this illness. *

QUESTION 3 OF 3 (B): Name the specific component of the sunlight spectrum which acts as the protective factor. *

QUESTION 3 OF 3 (C): What is the imaginary geographical coordinate that is useful in explaining this protective factor across regional populations? *

QUESTION 3 OF 3 (D): Name the Sri Lankan organization which conducts the above-mentioned conference. *

Name *

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Weekly Quiz - 8 January 2021

The video shows part of a brief examination of a 60-year-old lady complaining of occasional shaking of her hands in a busy clinic. The medications that she was on and few relevant investigations obtained are shown in the images.

Medications
Investigations

QUESTION 1 OF 4 (A): Name 3 possible causes for the appearance in the video from her medications and investigation results. *

QUESTION 1 OF 4 (B): What further tests would you order to confirm or rule out two of the causes you mentioned? *

There are many other medications that could cause this phenomena. Give a matching causative agent for the following

See below

QUESTION 2 OF 4 (A): An anti-epilectic medication that was historically most implicated in causing this phenomena *

QUESTION 2 OF 4 (B): A mood stabilizer medication having a metal as its component *

QUESTION 2 OF 4 (C): An anti-pseudomonal broad spectrum antibiotic *

QUESTION 2 OF 4 (D): An electrolyte abnormality associated with U waves in ECG *

QUESTION 3 OF 4 (A): What is the specific category of movement disorder to which this phenomena belongs? *

QUESTION 3 OF 4 (B): Name the popular medical terminology for this phenomena or sign *

QUESTION 4 OF 4: This terminology was coined in the mid twentieth century and was popularized through a pre-eminent American medical reference textbook on internal medicine. Subsequently this sign became a well known component of routine bed side clinical examination. Name this medical textbook. *

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Weekly Quiz - 1 January 2021

ASN wishes you a happy new year! Today is the first day of the Gregorian calendar which was introduced in October, 1582 by modification of the calendar in use until then. The earlier calendar was named after the legendary military commander-dictator who created it. It is chronicled that this dictator suffered from recurrent “episodes” of a neurological “illness”. One such “episode” occurred during a battle that took place on his return from conquest in Africa.

See below

QUESTION 1 OF 4: State the general medical terminology for the “episodes” and the “illness” that afflicted this dictator. *

QUESTION 2 OF 4: An infective agent prevalent in Africa could also cause these “episodes”. The most consumed meat of the dictator’s civilization was pork. Give the scientific name of the infective agent and name its neurological manifestation. *

QUESTION 3 OF 4: This dictator ruled at a time where many transmissible diseases were prevalent. Name three other infectious diseases that could cause these “episodes” under the transmission categories of respiratory, sexually and vector-based. *

The dictator, who remained of sound mind until his assassination, also suffered from episodic headaches. Based on this it is hypothesised that an intact vascular malformation could have caused both the “episodes” and the headaches.

See below

QUESTION 4 OF 4 (A): Name a modern investigation to confirm such a lesion. *

QUESTION 4 OF 4 (B): Name the latest clinical trial which provides evidence for long term management of such an intact vascular malformation and briefly state the trial’s initial conclusions. *

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Weekly Quiz - 25 December 2020

This image shows two powerful political leaders of the 20th century. They both passed away following the same neurological complication.

Image

QUESTION 1 OF 4: Name the neurological complication. *

QUESTION 2 OF 4: Neonates could also suffer the same complication, in which case the cause could be a rare haematological disorder with an eponymous name similar to the name given for today. Name the specific disorder and its specific deficiency state. *

QUESTION 3 OF 4: This disorder is also called “the royal disease” as it may have been spread to European royalty through a monarch nicknamed “the grandmother of Europe”. Name this monarch. *

QUESTION 4 OF 4: It is speculated that one of the gentlemen in the image suffered the complication due to a medication which creates a deficiency state including the specific deficiency of the haematological disorder above. This medication is commonly prescribed in Sri Lanka. Name the medication and describe its mechanism of action. *

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Weekly Quiz - 18 December 2020

Weekly Quiz - 11 December 2020

Weekly Quiz - 4 December 2020

QUESTION 1 OF 4: Name the widely accepted latest classification system for headaches. *

QUESTION 2 OF 4: According to that classification, name the clinical diagnoses/classification of the following headache scenarios (assume that the neurological examination is normal).

See below (a) and (b)

(a) A 25-year-old female presenting with her fourth episode of severe left sided throbbing headache associated with nausea and vomiting with the pain being worse on walking and each episode lasting from 6 hours to a full day. The first episode was two months ago. *

(b) This same patient presented over the next 4 months with many headache episodes around both temples once a week associated with mild photophobia but not phonophobia. Each episode varying between 1 hour to 12 hours in duration without nausea or any effect on daily activities. *

QUESTION 3 OF 4: A year later, she was asked to maintain a headache diary and then had noted the following over the next three months. Each consecutive month she had had 24, 19 and 15 headaches respectively. Ten, 9 and 8 headaches respectively were of the former headache type (described in 2-a) while the rest were of the latter headache type (described in 2-b). For all of these episodes she had taken either paracetamol or paracetamol+codeine and at least every other day oral sumatriptan or zolmitriptan. Name the two headache types affecting her at this point in time. *

QUESTION 4 OF 4: Her younger brother recently had two episodes of left sided hemianopia, vertigo and left hemiparesis accompanied by headache. The hemianopia fully reversed in 10 minutes, vertigo resolved within an hour and left hemiparesis & headache fully recovered within 24 hours in both instances. MRI studies with DWI images were normal both times. His paternal uncle had had similar episodes and was found to have a calcium channel mutation on genetic testing. What headache type do these men have? *

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Weekly Quiz - 14 August 2020

Two young men of a group of 5 were admitted to the emergency unit following an underground mining mishap. Five males had gone underground for treasure hunting. The light source in the tunnel had disappeared unexpectedly. The group had panicked and rushed out of the tunnel. Three of them climbed out without harm. The fourth was rescued and was in a confused state. The fifth man was found unconscious and was pulled out. The CT scans of the fourth and fifth men are shown respectively (A and B). The fourth man’s EEG showed mild encephalopathy. The fifth man was assessed by the Neurosurgical team and was advised to be electively intubated and hyperventilated with medications to reduce intracranial pressure. The fifth man also has a past history of epilepsy and was not on treatment. His companions neither confirm nor deny any foul play within the tunnel.

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QUESTION 1 OF 2: What is the neuro-radiological diagnosis for the fifth man’s CT scan? *

QUESTION 2 OF 2: What could be the possible cause for the fifth man’s presentation? *

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