RACP Divisional Written Exam · FRACP

Neurology for the written exam

Everything Physify has for Neurology: short lessons written to Australian guidance, exam-style questions with a worked explanation for each, and Bedside, our AI tutor, under every one. Try a question below, no sign-up.

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36courses
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302lessons
exam-style questions
844exam-style questions
figures in the lessons
28figures in the lessons

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Neurology

A 35 year old man with relapsing-remitting MS has received natalizumab 300 mg IV every 4 weeks for 30 months without relapse. Before natalizumab he had 12 months of mitoxantrone. His anti-JC virus antibody, negative at baseline, is now positive. Using the three-factor PML risk stratification published by Bloomgren and colleagues in 2012, what is his approximate risk?

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What's covered

36 courses, each a set of lessons with a quiz after them. The bar shows how many questions each has. Open a course to see its lesson outline.

From the lessons

28 figures sit in the Neurology lessons: ECGs, diagrams, films and clinical images, each with what to look for. Here are 4. Tap one to enlarge it.

Schematic circle of Willis viewed from below, anterior at the top: the two vertebral arteries join to form the basilar artery, which divides into the two posterior cerebral arteries; each posterior communicating artery joins a posterior cerebral artery to the internal carotid artery; each internal carotid artery divides into the middle cerebral artery, running laterally, and the anterior cerebral artery, the two anterior cerebral arteries joined by the anterior communicating artery. A coronal section colours the territories: the anterior cerebral artery supplies the medial surface and a strip over the vertex, where the leg area of the motor cortex lies; the middle cerebral artery supplies the lateral convexity with the trunk, arm, hand and face areas, and the basal ganglia through deep branches; the posterior cerebral artery supplies the thalamus and the inferomedial temporal lobe. Below, the syndromes: anterior cerebral artery occlusion causes contralateral weakness and sensory loss affecting the leg more than the arm, urinary incontinence and abulia, and akinetic mutism when both arteries arise from one A1; middle cerebral artery occlusion causes contralateral face and arm more than leg weakness and sensory loss, homonymous hemianopia and gaze deviation towards the lesion, with aphasia (Broca from the superior division, Wernicke from the inferior division) when the dominant, usually left, hemisphere is affected and neglect, anosognosia and dressing apraxia when the non-dominant hemisphere is affected; posterior cerebral artery occlusion causes a contralateral homonymous hemianopia with macular sparing, alexia without agraphia when the dominant side and splenium are involved, later thalamic pain, amnesia from medial temporal infarction and cortical blindness when both are occluded.
Physify teaching diagram (schematic). Tap the image to zoom.

From the lesson “Vascular Territories, Lacunar Syndromes and Localisation” in Stroke, Transient Ischaemic Attack and Common Causes

Chart of CSF white cell count on a log scale (1 to 10,000 x 10^6/L) against glucose, normal or low (a CSF to serum ratio below 0.5, usually below 0.4 in bacterial meningitis, or glucose below 2.2 mmol/L), coloured by the predominant cell. Normal glucose: normal CSF, up to 5 cells; viral, lymphocytes usually under 500, ranging to about 1000, with neutrophils early. Low glucose: bacterial, usually over 1000, often 1000 to 5000, with over 80 per cent neutrophils; tuberculous, lymphocytes 100 to 500; cryptococcal, scant lymphocytes, named without a band because no range is given. A table adds opening pressure, protein and a clue for each: normal, 10 to 25 cmH2O, protein 0.15 to 0.45 g/L, glucose about 60 per cent of plasma; bacterial, often over 25 cmH2O (cut-offs vary), protein over 1 g/L, cloudy, Gram stain, cover Listeria if aged over 50, pregnant or immunosuppressed; viral, protein under 1 g/L, HSV PCR can be negative in the first 72 hours so repeat it if suspicion persists; tuberculous, protein 1 to 5 g/L, ADA above 8 U/L supports TB but does not separate it from bacterial meningitis; cryptococcal, very high opening pressure, cryptococcal antigen, and repeat LPs if pressure is 25 cmH2O or more. Blank cells mean no figure is given; a traumatic tap adds about 1 white cell per 700 to 1000 red cells.
Physify teaching diagram (schematic), shared with the Neurological Diagnostics course; tuberculous and cryptococcal CSF are covered in Cryptococcal and Tuberculous Meningitis. Tap the image to zoom.

From the lesson “Bacterial Meningitis: Organisms, Clinical Features and the CSF” in Infections of the Central Nervous System

Schematic cross-section of the spinal cord viewed from above, anterior at the top and the patient's left on the left, showing the H-shaped grey matter, the dorsal columns posteriorly (gracile medially carrying the legs, cuneate laterally carrying the arms), the lateral corticospinal tracts in the posterior lateral columns and the spinothalamic tracts anterolaterally. A pain fibre enters through the right dorsal root and crosses in the anterior white commissure to the left spinothalamic tract. A frontal pathway view for the right side of the body shows the corticospinal tract leaving the left cortex, crossing in the lower medulla and descending in the right cord to the right-sided muscles (85 to 90 per cent of fibres cross; the rest descend uncrossed in the anterior corticospinal tract); the dorsal columns ascending on the right to the medulla, then crossing to the left cortex; and spinothalamic fibres crossing within 1 to 2 segments of entry and ascending on the left. Four hatched lesions follow. Brown-Sequard (right hemisection): below the level, right-sided upper motor neurone weakness with loss of vibration and proprioception, and left-sided pain and temperature loss from 1 to 2 segments below; at the level, right-sided lower motor neurone weakness and loss of all sensation in 1 to 2 dermatomes. Anterior cord (anterior two-thirds, anterior spinal artery): bilateral paralysis and pain and temperature loss below the level with urinary retention, vibration and proprioception spared. Central cord (hyperextension of a spondylotic neck): weakness of the arms more than the legs, hands most, and bilateral pain and temperature loss in a cape at the lesion's own segments, with the dorsal columns relatively spared and sacral sparing. Posterior cord (B12 or copper deficiency, nitrous oxide, tabes dorsalis): bilateral loss of vibration and proprioception below the level with sensory ataxia and a positive Romberg sign, power, pain and temperature spared unless the lateral columns join in, as in subacute combined degeneration.
Physify teaching diagram (schematic). Tap the image to zoom.

From the lesson “Incomplete Cord Syndromes: Central, Brown-Sequard, Anterior and Posterior” in Spinal Anatomy & Pathology

Schematic of the visual pathway viewed from above, with temporal retinal fibres staying on their own side and nasal fibres crossing at the chiasm, so each optic tract, lateral geniculate nucleus, optic radiation and occipital cortex carries the opposite half of the visual field. Six numbered lesions with their field charts, drawn as the patient sees them: 1, left optic nerve: loss of the whole left eye field; 2, chiasm: bitemporal hemianopia; 3, left optic tract: an incongruous right homonymous hemianopia, drawn unequal in the two eyes; 4, left Meyer's loop in the temporal lobe: right superior homonymous quadrantanopia, often incongruous and drawn unequal in the two eyes; 5, left parietal radiation: right inferior homonymous quadrantanopia; 6, left occipital cortex: right homonymous hemianopia with macular sparing. A note says the further back the lesion, the more congruous the defect.
Physify teaching diagram (schematic). Tap the image to zoom.

From the lesson “Retrochiasmal Field Loss, Hemianopia and Charles Bonnet Syndrome” in Neuro-Ophthalmological Disorders

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Neurology in the clinical exam

29 interactive short cases and 7 long cases for the RACP Divisional Clinical Exam: you examine, present and are marked on the five RACP domains.

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Neurology on the blog

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