Preface:

    Here, you can find new questions in addition to our old series. Please feel free to comment and to contact us. Again, these best of fives are not a substitute for textbooks, please read the corresponding topics well in textbooks, and then review and test your knowledge.

    I would like to thank my dear friends in Al-Sulaimaniya general hospital (IRAQ) for their kind help and support regarding the collection of cases from their departments during my visit there. Thanks to: Dr. Dana Ahmad (neurologist), Dr. Diyar Najeeb (neurologist), Dr. Dana Mahmood (physician), Dr. Saad Shwani (neurologist), and Dr. Ahmad Saed (physician).

   Please feel free to contribute and to share your experience with all. We are welcoming new writers.     

Thank you visiting our website.

 
Dr. Osama Amin

Head of Team Neurology4MRCP

April 2006

All Questions and answers were written by Dr. Osama Amin

Copyright2006. All rights reserved.

http://neurology4mrcp.orgfree.com

Q1:

A 23-year-old housewife presents with 2 day history of numbness and weakness in her left arm to be followed by numbness in her right leg after 1 day. Her past medical history is unremarkable, with no history of spinal trauma or medication abuse.

Examination revealed loss pinprick sensation in her right leg up to the lateral aspect of her right arm and loss of position sense in the left lower and upper limbs, with left sided up-going planter. She reported some spontaneous improvement after 5 days.

All of the following statements are wrong, except:

1. She is unlikely to have a partial Brown-Squard Syndrome.
2. Multiple sclerosis is excluded by this picture.
3. Breast examination is unhelpful.
4. MRI of the cervical cord is indicated.
5. CT scan of the head should be the top priority.

Q2:

A 67-year-old man presents with one-day history of a sudden onset of difficulty in swallowing and vertigo. Examination revealed impaired gag reflex and sensation in the right pharynx, coarse horizontal nystagmus, and dysarthria. His past medical history is unremarkable. A diagnosis of ischemic brainstem stroke was done. Which one is the correct statement?

a. He dose not need aspirin.

b. Carotid Doppler study should be omitted.

c. Asymptomatic hyperglycemia will not change the management plan.

d. Severe cervical spondylosis can be a risk factor for his stroke.

e. He should receive Thrombolytic therapy.

Q3:

A 62-year-old woman presents with a few hours history of headache and confusion. Her non-contrast brain CT scan showed right basal ganglia hematoma. At day 4, she developed generalized tonic clonic fit. All of the followings are true, except:

a. She needs another brain CT scan.

b. Assessing her serum sodium level is worthy.

c. He fits are likely to represent pseudo-seizures

d. The blood pressure should be monitored.

e. Careful assessment of her fluid status should not be forgotten.

Q4:    

A 51-year-old woman who was diagnosed as having a right sided frontal lobe meningioma recently, came with a 1-day history of irregular jerky movements of her right arm that is at the side of the tumor. The description is consistent with a focal motor seizure. You reviewed her brain CT scan to be sure of the site of the tumor. How can you explain the site of the seizures?

a. She is lying.

b. The CT scan does not belong to her.

c. There is another left sided cortical tumor that is not seen by the brain CT scan.

d. You are reading the CT scan film in a reversal manner.

e.  She might have an uncrossed pyramidal system of fibers.

Q5:

A 21-year-old man presents with a 2-day history of impaired consciousness. His mother said that he has recently been diagnosed as having a psychiatric illness and is receiving certain tablets for it. Examination revealed high fever, generalized rigidity, fluctuating blood pressure and pulse rates. What is the likely psychiatric illness?

a. Severe endogenous depression.

b. Panic attacks.

c. Schizophrenia.

d. Hypomania.

e. He has no psychiatric illness at all.

Q6:

A 14-year-old girl is being evaluated for an abnormal gait. The final diagnosis was Friedreick's ataxia. However, you noticed something that is against her diagnosis, what is it?

a. Marked cognitive impairment.

b. Hyperglycemia.

c. Retinitis pigmentosa.

d. Scoliosis.

e. Negative family history.

Q7:

A 51-year-old woman came with rapid and progressive impairment in her vision affecting her left eye only over a matter of few days. Apart from red swollen left optic disc with severely reduced visual acuity to finger counting and Marcus-Gunn pupil, her examination is totally unremarkable. Few days later while she is in the way of investigations, she said that her vision is better now. Which one is the correct statement?

a. Brain MRI with contrast is not indicated.

b. Auto antibody screen is useless.

c. Her ESR would give no clues.

d. The findings are consistent with Foster Kennedy syndrome.

e. Gradual and excellent improvement is against giant cell arteritis.

Q8:

A 32-year-old man presents with a 2-year history of left sided headache and ocular pain. The pain seems to occur in severe bouts for about two hours, with eye redness and nasal watering, day and night, with no remission, somewhat responsive to phenacetin. He is non-smoker and non-alcoholic, on no medications or illicit drugs. Examination revealed only gynecomastia and soft testes.Which one is the correct statement?

a. He has migraine without aura.

b. This is malingering.

c. Brain MRI or CT scan should be done.

d. Increasing the dose of phenacetin is helpful.

e. Reassure and discharge him.

 Q9:

A 5-year-old girl is being treated by chemotherapy for acute lymphoblastic leukemia, and she is in the 4th week of remission induction phase, developed partial left sided ptosis with diplopia, generalized headache, and progressive massive weight gain in spite of loss of apatite. All of the followings are wrong, except?

a. Her weight gain is likely to be due to hypothalamic infiltration.

b. CSF examination is contraindicated.

c. Vincristine toxicity is the cause of ptosis.

d. Prednisolone is the cause of her obesity.

e. Cranial irradiation is of no benefit.

Q10:

A 40-year-old man was admitted because of progressive somnolence over few days. He has a history of extensive chronic plaque psoriasis for which he is receiving cyclosporine. Examination revealed fever, neck stiffness and obtundation. Which one is the correct statement regarding his new presentation?

a. We should increase the dose of cyclosporine.

b. CSF examination is unnecessary.

c. Start intravenous cefotaxime and vancomycine.

d. Add azathioprine.

e. Blood cultures should be avoided.

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