Q11:
A 21-year-old woman, who was reasonably well and healthy, presents with 4-month history of progressive unsteadiness in stance and gait. She denied any drug abuse or a back trauma, and there are no risk factors for HIV infection, and no family history of a similar condition. Examination revealed spastic paraparesis with loss of join position and vibration sense in the lower limbs and right-sided primary optic atrophy. No sensory level was detected. What is your next step?
a. Observation only.
b. Give high dose pulse intravenous methylprednisolone.
c. Give vitamin B12 injections.
d. Plain X ray of the lumbosacral spine.
e. Brain MRI with contrast.
Q12:
A 57-year-old woman with a history of mitral stenosis presents with sudden onset of right sided weakness and global aphasia.
Which one is the correct step?
Q13:
A 20-year-old woman presents with long standing history of mild lower limb weakness that is very slowly progressive since the age of 12 years, associated with some sensory numbness. She is not bothered by the weakness, but she is embarrassed by her legs' appearance. Her older sister has a same condition. Examination revealed bilateral pes cavus, hammertoes, and thin stork-like legs. The right common peroneal nerve was palpable. Her past medical history is unremarkable. She refused to be examined further.
What is the most likely diagnosis?
Q14:
A 60-year-old right-handed man has a history of embolic stroke, and he is aphasic. His speech is non-fluent, with impaired repetition and naming, but relatively intact comprehension. Where is the site of the lesion that is likely to be responsible for his aphasia?
a. Upper posterior temporal gyrus, left hemisphere.
b. Left frontal pole.
c. Left mesial temporal lobe.
d. Lower posterior inferior frontal gyrus, left hemisphere.
c. Right occipital pole.
Q15:
A 20-year-old man presents with generalized tonic clonic seizures. He is a know case of idiopathic grand mal epilepsy and he was put on valproic acid tablets since 2 years. All of the followings are well-know side effects of this medication, except:
a. Thrombocytopenia.
b. Pancreatitis.
c. Alopecia.
d. Tremor.
e. Weight loss.
Q16:
An 18-year-old female, was referred to you from the psychiatric department. She was initially diagnosed as having schizophrenia, but investigations revealed impaired liver function tests prior to starting her conventional antipsychotic, and further work up revealed Wilson's disease. An ophthalmologist detected Kayser-Fleischer ring in both eyes. What is the anatomical site of this "ring"?
Q17:
A 47-year-old man with long standing history of acromegally is seen by you in the clinic for a routine follow up visit. Some of his nerves were palpable. All of the following conditions can produce palpable nerves, except?
a. Primary AL Amyloidosis.
b. Charcot Marie Tooth disease type I (CMT I).
c. Rufsum's disease.
d. Guillain Barre syndrome (GBS).
e. Chronic inflammatory demyelinating polyradiculopathy (CIDP).
Q18:
A 7-year-old boy presents with poor school records for the past 2 months. He was cleaver and has no family problems. Examination was otherwise unremarkable. Further work up had revealed petit mal epilepsy. Which one of the following medication can cause worsening of his condition?
a. Valproic acid.
b. Ethosuximide.
c. Carbamazepine.
d. Lamotrigine.
e. Clonazepam.
Q19:
A 28-year-old female presents with an attack of weakness in her lower limbs. She has a history of short-lived numbness and severe blurred vision both of which improved spontaneously. Ultimately, she was diagnosed as having multiple sclerosis. Which one of the following conditions is against the diagnosis of multiple sclerosis?
a. Partial Brown-Squard syndrome.
b. Bilateral trigeminal neuralgia.
c. Rubral type tremor.
d. Dorsal column signs in one limb.
e. Swollen optic nerve heads with visual acuity of 6/6.
Q20:
A 37-year-old man presents with 2-day history of fever and confusion. His brother said that the patient does not have any illness and on no medications or illicit drugs. He has no risk factors for HIV infection, and no history of head trauma. Examination documented a temperature of 38.9 C, global confusion and neck stiffness. What is your immediate action apart from ABC (airway, breathing, circulation)?
a. Order a brain CT scan with contrast.
b. Order a Brain MRI without contrast.
c. Start intravenous Ceftriaxone and Vancomycin.
d. Send a blood sample for HIV testing.
e. Give nimodipine.
Q21:
A 17-year-old male presents with few days history of lower limb weakness in the absence of spinal trauma. There was a bout of diarrhea before 3 weeks. There is flaccid areflexic proximal and distal weakness with no objective sensory signs, and flexor planters. You put a preliminary diagnosis of Guillain Barre syndrome. Which one is the correct statement regarding this syndrome?
a. Dysautonomia is very rare.
b. Marked asymmetric signs are expected in the majority.
c. The mortality rate is around 40%.
d. A normal CSF protein level excludes the diagnosis.
e. Relapses are seen.
Q22:
A 28-year-old man brought by his family to consult you. They said that the patient sometimes stares suddenly with embarrassing picking at clothes movements with funny lip smacking. The patient did admit to feeling of a sudden rising sensation in the upper abdomen with nausea but he did remember the staring or these "embarrassing" movements. A coronal MRI of brain showed left sided mesial temporal lobe atrophy. Which one of the following statements is the correct one regarding his illness?
a. The patient should be referred to a psychiatrist.
b. Carbamazepine is useless.
c. The patient may be selected for anterior temporal lobectomy.
d. Hippocampal atrophy would be unusual in biopsy specimens.
e. EEG usually shows generalized spike and wave activity.
Q23:
A 51-year-old woman, with a cured early breast cancer since 10 years, presents with many months history of generalized headache and early morning vomiting. Examination revealed florid papillodema.
a. There is no association between breast cancer and meningiomas.
b. Underlying massive brain edema is seen in all cases.
c. Multiple meningiomas are seen in neurofibromatosis type 2.
d. The tumor regresses spontaneously in the majority of cases.
e. The spinal cord is the commonest site.
Q24:
A 63-year-old man, with type 2 diabetes and hypertension, presents with one-day history of sudden difficulty in swallowing, vertigo, and vomiting. A diagnosis of brainstem ischemic stroke was made. Which one of the following neurological signs is not an indicative of brainstem pathology?
a. Vertical nystagmus.
b. Aphasia.
c. Internuclear ophthalmoplegia.
d. Horizontal gaze palsy.
e. Onion skin pattern of loss of sensation in the face.
Q25:
A 25-year-old woman presents with few weeks history of generalized headache, vomiting, and blurred vision.
a. The idiopathic variety is the commonest type.
b. Absence of headache should cast a doubt on the diagnosis.
c. Primary optic atrophy is the most fearful complication.
d. Treatment with steroids should be avoided.
e. Optic nerve sheath fenestration protects the operated eye only.
Q26:
A 7-year-old boy with few weeks' history of lethargy and progressive pallor was found to have acute lymphoblastic leukemia L2-subtype. He is complaining of headache and double vision. Non-contrast brain CT scan was normal. Lumbar puncture under platelets infusion showed a CSF filled with blasts and raised protein. Which one of the following statements is true regarding CNS involvement in leukemia?
a. It does not affect he overall prognosis.
b. Neck stiffness is seen in the absence of pyogenic meningitis.
c. A single negative CSF sample excludes leukaemic meningitis.
d. Intrathecal methotrexate should be avoided.
e. The spine, but not the cranium, should be irradiated.
Q27:
A 67-year-old woman with a longstanding type 2 diabetes presents with transient speech defect and right sided weakness. A diagnosis of hemispheric TIA was done. All of the followings can be seen in anterior circulation strokes except?
a. Amaurosis fugax.
b. Motor Aphasia.
c. Transcortical sensory aphasia.
d. Nystagmus.
e Hemiplegia.
Q28:
A 56-year-old man patient is being evaluated after sustaining a stroke with a resultant aphasia. Which one of the followings can result from a dominant hemispheric lesion only?
a. Asteriognosis.
b. Urinary incontinence.
c. Hemiplegia
d. Transcortical motor aphasia.
e. Constructional apraxia.
Q29:
A 58 year old, with post-stroke epilepsy on carbamazepine tablets and is seizure free, presents with few days' history of unsteadiness and double vision following upper respiratory tract infection, which was treated successfully with clarithromycine.
Which one of the followings is responsible for his new presentation?
Q30:
A 22-year-old diabetic man since 10 years is being evaluated for autonomic neuropathy because of orthostasis symptoms and impotence. Autonomic neuropathy is not seen in?
a. Amyloidosis.
b. Alcoholism.
c. Guillain Barre syndrome.
d. Motor neuron disease.
e. HIV infection.
Q31:
A 48-year-old man, who was completely healthy, presents with a 3-week history of headache, fever, anorexia, and a double vision. Examination revealed confusion, fever, neck stiffness, and bilateral abducense palsy with florid papillodema.
His non-contrast brain CT scan showed hydrocephalus but no mass lesion. CSF analysis revealed an opening pressure of 30 cm H2O, cloudy fluid, lymphocytic pleocytosis with 90% lymphocytes, protein 400 mg/dl, and sugar 20 mg/dl (random blood sugar 110 mg/dl). His plain chest x ray showed evidence of old hilar calcifications. He has a family history of a certain chest disease with cough and wasting. Which one is the correct statement regarding his illness?
Q32:
A 67-year-old man presents with an 8 month history of speech difficulty and coughing upon swallowing. Examination revealed dysarthria, small conical tongue, exaggerated gag reflex and jaw jerk. Which one of the followings is not a potential cause of this condition?
a. Motor neuron disease.
b. Bilateral hemispheric lacunar strokes.
c. Myasthenia gravis.
d. Brainstem vasculitis.
e. High brainstem tumors.
Q33:
A 61-year-old man presents with progressive gait difficulty and abnormal speech. Examination revealed wide spread fasciculation and muscle wasting. A preliminary diagnosis of motor neuron disease was made. The presence of which one of the followings is not considered to be against the diagnosis?
a. Parkinsonian features.
b. Ocular palsies.
c. Urinary incontinence.
d. Upper and lower motor neuron signs in one limb.
e. Unilateral cerebellar signs.
Q34:
A 28-year-old woman with a relapsing remitting multiple sclerosis is being evaluated in your clinic. She has bilateral central scotomas, and fundoscopy revealed flat optic nerve heads of whitish color and clear margins. All of the following conditions can cause this optic nerve head picture, except?
a. Vitamin B12 deficiency.
b. Friedreick's ataxia.
c. Surpatentorial meningioma.
d. Tobacco-alcohol amblyopia.
e. Vasculitis.
Q35:
A 31-year-old woman has primary progressive multiple sclerosis since 2 years with no remission at all. Which one of the following features is against the diagnosis of multiple sclerosis?
a. Transverse myelitis.
b. Horner's syndrome.
c. Optic neuritis.
d. Aphasia.
e. Internuclear ophthalmoplegia.
Q36:
A 56-year-old man presents with 6 months history of generalized headache. He was completely healthy and reasonably well, on no medications or illicit drugs . He is a life long non-smoker and non-alcoholic, with no risk factors for HIV infection. His brain MRI is suggestive of a left sided frontal lobe oligodendroglioma.
Which one of the followings is not true regarding this primary brain tumor?
Q37:
A 61-year-old woman, who was reasonably well and enjoyed independent life, presents with 2-month history of depressed mood. Her son stated that his mother is not interested in anything, and she talks very little. She did respond to a trial of fluoxitine tablets prescribed by her general practitioner since 4 weeks. Her brain MRI is consistent with a large right sided frontal lobe glioblastoma multiforme.
Which one of the followings is true regarding this brain tumor?
Q38:
A 68-year-old woman brought by her daughters to consult you regarding the memory status of their mothers. They stated that their mother is becoming gradually forgetful and anxious, while the patient denies this during the interview. She scored 20 on mini mental status examination (MMSE). After an extensive work up, you diagnosed Alzheimer's disease, and you are thinking of giving donepezil to her.
Which one of the followings is true regarding this medication?
Q39:
A 62-year-old man, diagnosed as having idiopathic Parkinson's disease since 5 months, is not responding to Sinemet tablets. Further workup disclosed a diagnosis of normal pressure hydrocephalus (NPH).
Which one of the followings is true regarding this type of hydrocephalus?
Q40:
A 21-year-old man is extremely anxious. He stated that his father died at the age of 45 years because of Huntington's disease (HD), and he is afraid that he might be silently affected. Which one of the followings is true regarding this fatal neurological illness?
a. It is an autosomal recessive disease.
b. There is GGG tri-nucleotide repeat expansion in HD gene.
c. Should be differentiated from benign familial chorea.
d. Seizures are frequent in adult cases.
e. Parkinsonian features are very common in late onset cases.
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