Business case study. Please answer all the questions. Make your responses to the negotiation questions more credible. The Textile unit needs 10,000 paper cones per day from a contractor. He learns he can produce 25,000 sheets of paper a day when he starts a production run. Holding a cone in stock for a year costs 2 pence, and starting a production run costs Rs.18. Per year in the factory, there are 300 working days.

Question1.

How can the Glasgow Coma Scale be assessed in a patient with receptive or expressive aphasia?

Question 2.

How common is it for someone suffering a transient ischaemic attack (TIA) to totally lose consciousness? Also, what is the mechanism for losing consciousness with a TIA? Question 3.

What should the management be for a stenosis in the carotid artery causing transient ischaemic attack (TIA), and when is surgery recommended?

Question 4.

In a patient with central retinal artery branch occlusion with carotid artery stenosis, what is the best management: warfarin, aspirin or carotid endarterectomy?

Question 5.

If a young patient who has suffered a stroke has a normal mental state, would this exclude a cerebral venous occlusion as an aetiology?

Question 6.

Does persistent hiccough following cerebrovascular ischaemic stroke localize to the medulla or to any other site?

Question 7.

By what mechanism is vertebrobasilar insufficiency associated with circumoral numbness? Question 8.

Why does lateral medullary syndrome result in ipsilateral diplopia due to cranial nerve VI?

Question 9.

I have seen many established ischaemic stroke patients with CTdocumented capsular infarction and hemi-hypotonia despite exaggerated reflexes. How would you explain the hypotonia? Could it be due to a corticorubral fibre lesion?

Question 10.

Thrombolytic therapy is used in patients with a cerebral infarct within the first 3 hours, whereas stroke by definition lasts 24 hours. So how do we define that it is infarct and not a transient ischaemic attack (TIA) on a CT scan within the first 3 hours in order to start tissue plasminogen activator (tPA) treatment?