Q41:

A 57-year-old man, presents with 8-month history of resting hand tremor and gait difficulty. Ultimately, he was diagnosed as having idiopathic Parkinson's disease, and you are thinking of prescribing a medication for his illness.

Which one of the following statements is correct regarding medical therapy of this disabling neurological disease?

1. Benztropine is an excellent option in old people with rigidity.
2. Amantidine produces a long lasting benefit.
3. Dopamine is the pro-drug of L-dopa.
4. Pramipexol is a D6 receptor agonist.
5. Tolcapone enhances the effect of L-dopa therapy.

 Q42:

A 22-year-old man sustained a trauma to the upper spine following a fall from his motor cycle. There are features of acute painful transverse myelopathy at the level of C6,7. Imaging studies confirmed the presence of an acute hematomyelia.

Which one is the correct statement regarding this spinal cord hematoma?

1. An underlying AVM may be present.
2. Extension into the subarachnoid space never occurs.
3. Vasculitis can not cause this hematoma.
4. Treatment is mainly by surgical evacuation.
5. Selective spinal angiography should be avoided in all cases.

 Q43:    

A 54-year-old man presents with repetitive severe lancination pains in his lower limbs and unsteady gait. You found bilateral small pupils with light-near dissociation. He has a history of poorly treated syphilis 20 years ago.

Which one of the followings is true regarding tabes dorsalis?

1. The patient may present as a medical acute abdomen.
2. Rombergism is present in all cases.
3. Vibration sense in the lower limbs should be intact.
4. Urinary frequency and urge incontinence are seen.
5. Extensor planters can be elicited

 
Q44:

A 26 year old woman, was diagnosed a having relapsing remitting multiple sclerosis (RRMS) since 1 year, and is currently receiving interferon beta therapy.

All of the followings are reasons to stop these medications in RRMS, except?

1. Development of severe depression with suicidal ideation.
2. Pregnancy.
3. Severe bone marrow suppression.
4. Development of one severe relapse after 1 year of therapy.
5. Development of secondary progression with no superimposed relapses.

 

Q45:

A 16-year-old schoolgirl who is a known case of idiopathic generalized tonic clonic epilepsy, currently receiving valproic acid tablets and is seizure free for the past 3 months, is consulting you about which medications to avoid, because she was surfing the internet and found that some mediations may worsen her epilepsy.

Which one of the following medications does not reduce seizure threshold?

1. Amphetamine.
2. Cyclosporine.
3. Acyclovir.
4. Meperidine.
5. Levitiracetam.

 
Q46:

A 65 year old man, was diagnosed as having amyotrophic lateral sclerosis (ALS) since 1 month, is referred to you for consideration as whether to start Riluzole or not.

Which one of the followings is true regarding this medication?

1. It has an anti-GABA effect.
2. Is nephrotoxic.
3. Produces modest improvement in survival figure.
4. Can cause weight gain.
5. Give as an intermittent intravenous infusion.

 
Q47:

A 32 year old man, with post primary pulmonary tuberculosis (TB) and is receiving anti TB medications since 5 months, presents with abnormal sensation in his feet. A diagnosis of isoniazide-induced peripheral neuropathy was made.  

All of the followings can cause sensory or predominately sensory peripheral neuropathy, except?

1. Cisplatin.
2. Dapsone.
3. Vincristine.
4. Metronidazole.
5. Paclitaxil.

Q48: 

A 44-year-old woman with history of watery diarrhea before 2 weeks presents with rapidly progressive areflexic weakness in her lower limbs. A diagnosis of Guillain Barre syndrome was made.

The followings can cause demyelinating peripheral neuropathy, but which one is the cause of primary axonal peripheral neuropathy?

1. Hypothyroidism.
2. Vitamin B12 deficiency.
3. Chronic liver disease.
4. Waldenstroms macroglobulinemia.
5. Diphtheria.

 

Q49:

A 34-year-old woman with generalized myasthenia gravis complains of cramping abdominal pains after the intake of pyridostigmine.

Which one of the followings is true regarding the treatment modalities in myasthenia gravis?

1. Intravenous immunoglobulin is used in cholinergic crisis.
2. Thymectomy is indicated in congenital myasthenic syndromes.   
3. Pyridostigmine can produce long lasting remission.
4. Prednisolone may cause a transit initial worsening.
5. Cyclosporine is contraindicated.

 

Q50:

A 58-year-old man, with a history of ischemic heart disease, presents with generalized body aches and weakness that interfere with his daily job as a laborer. He is on Aspirin, atenolol, and lovastatin. After 2 weeks of stopping lovastatin, he reported a marked improvement in his weakness and pains.

Which one of the followings is not a cause of drug-induced myopathy?

1. Zidovudine.
2. Cyclosporine.
3. Gemfibrozil.
4. Paracetamol.
5. Penicillamine.

 
 

Q51:

A 62-year-old man presents with slowly progressive distal weakness and wasting in both upper and lower limbs. There is absent knee jerks and flexor planters. EMG and muscle biopsy studies confirmed a diagnosis of inclusion body myositis (IBM).

Which one is the correct statement regarding this form of inflammatory myopathy?

1. There is degeneration of anterior horn cells.
2. A positive family history should be absent.
3. Usually resistant to immune suppressive therapy.
4. The presence of rimmed vacuoles on biopsy specimens is suggestive of an associated dermatomyositis.
5. The prognosis is excellent.

 

Q52:

A 22-year-old man is consulting you because he has a relative with a muscular dystrophy who died because of cardiac arrest.

Which one of the following muscular dystrophies is not associated with cardiac involvement?

1. Becker's muscular dystrophy.
2. Duchenne's muscular dystrophy.
3. Emery-Dreifus muscular dystrophy.
4. Facioscapulohumeral muscular dystrophy.
5. Myotonia dystrophica.

 

Q53:

A 61-year-old man presents with recurrent orthostasis symptoms. He is hypertensive and is taking captopril and hydrochlorothiaziade tablets. He is afraid that he might have a brain disease causing this picture.

Autonomic dysfunction can be associated with many central and peripheral neurological diseases. Which one of the following autonomic dysfunction-causing diseases is not associated with CNS signs?

1. Multiple sclerosis.
2. Botulism.
3. Multiple system atrophy.
4. Tabes dorsalis.
5. Parkinson's disease.

 

Q54:

A 29-year-old new married woman is consulting you about the likelihood of having a child affected by mitochondrial diseases, because she has a relative with one of these diseases.

Which one of the following diseases is not due to mitochondrial cytopathy?

1. Kearns-Sayre syndrome.
2. MERRF (myoclonic epilepsy with ragged red fibers).
3. MELAS (mitochondrial encephalopathy with lactic acidosis and stroke like episodes).
4. Leigh's disease.
5. Machado-Joseph's disease.

 

 Q55:

A 22-year-old man presents with 3-week history of progressive somnolence and headache. He has a history of poorly treated frontal sinusitis before 1 month. Brain CT with contrast revealed a large right-sided frontal mass with ring enhancement and massive surrounding edema and midline shift.

Which one of the followings is true regarding brain abscesses?

1. In 90% of cases, no obvious source of infection can be found.
2. The surrounding edema is cytotoxic in type.
3. Fever is present in 50% of cases.
4. Lumbar puncture should be done to isolate the infectious agent.
5. After treatment, only 5% will have seizures.

 
Q56:

A 34-year-old woman, presents with 3 days history of fever, headache, confusion and seizures. Brain MRI findings were suggestive of herpes simplex encephalitis. Which one is the correct statement regarding this type of viral encephalitis?

a. Bilateral temporal involvement is common.

b. About 50% of PCR-proven cases will have a normal brain MRI.

c. The virus can be cultured from the CSF in 75% of cases.

d. The negative predicative value of a negative CSF PCR assay for HSV DNA is only 2%.

e. Acyclovir should be started only after CSF PCR is done.

 

Q57:

A 63-year-old woman presents with rapidly progressive dementing illness and myoclonus.

Which one of the followings is not against the diagnosis of Cruetzfeldt-Jakob disease (CJD)?

1. Fever.
2. Peripheral blood neutrophilic leukocytosis.
3. Neutrophilic CSF pleocytosis.
4. ESR of 110.
5. Positive CSF protein 14-3-3.

 
Q58:  

A 57-year-old man presents with 3-week history of confusion, headache, vomiting, and right sided weakness. He is a life long smoker, and recently had a chest X ray showing a large cavitating mass near the upper right hilar area. Brain CT scan showed multiple masses that could be metastases.

Which one of the followings is true regarding treatment of raised intracranial pressure (ICP)?

1. Draining CSF via ventriculostomy should be avoided.
2. The head of bed should not be elevated.
3. Hemi-craniectomy is used in refractory elevated ICP.
4. Steroids are highly effective in hemorrhagic stokes.
5. Plasma osmolality should be kept above 320 mosmol/Kg when using mannitol.

  

 Q59:

An elderly vagrant man brought to the A/E department by the ambulance in a severe dehydrated state, and rehydration was started. The next day, he became quadriplegic.

Which one of the followings is true regarding central pontine myelinolysis (CPM)?

1. May result from too slow correction of dehydration.
2. There is demyelination at the basis pontis without inflammation.
3. The presence of pseudobulbar palsy should suggest another diagnosis.
4. The absence of quadriparesis should cast a doubt on the diagnosis.
5. Has an excellent prognosis.

 

Q60:

A 59-year-old man presents with 1-hour history of aphasia and dense right sided weakness. Brain CT scan revealed no evidence of intracranial hemorrhage, any mass lesion, or midline shift. A diagnosis of ischemic stroke was made and you are considering thrombolytic therapy to be given.

The presence of all of the followings should exclude him from receiving this mode of therapy, except?

1. Rapidly improving symptoms.
2. Blood glucose of 500 mg / dl.
3. Elevated INR.
4. Hematocrit of 20%.
5. Onset of symptoms to the time of drug administration is less 3 hours.

 

Q61:

A 22-year-old college student brought by his friends to the A/E department with sudden onset of unsteady gait. He is grossly ataxic for stance and gait.

Which one of the followings is not a cause of acute cerebellar ataxia?

1. Alcohol intoxication.
2. Lithium toxicity.
3. Post-infectious cerebellitis.
4. Cerebellar hemorrhagic stroke.
5. Hypothyroidism.

 
Q62:

A 15-year-old male presents with slowly progressive gait unsteadiness and abnormal speech. You detected pes cavus, scoliosis, cardiomyopathy, absent ankles, extensor planters, and nystagmus. Your provisional diagnosis is Friedreick's ataxia.

He has two relatives affected by this disease. Which one of the followings is not inherited as a cause of spinocerebellar ataxia?

1. Machado-Joseph disease.
2. Kearns-Sayre syndrome.
3. Episodic ataxia type II.
4. Ataxia telangiectasia.
5. Leigh's disease.

 
Q63:

A 21-year-old woman presents with 2-day history of headache, fever, and mild confusion with neck stiffness. Her CSF revealed elevated opening pressure, lymphocytic pleocytosis, raised protein and normal sugar. Viral meningitis was diagnosed.  

Which one of the following infectious viral agents is considered to be a common cause of this type of meningitis?

1. Cytomegalovirus (CMV).
2. Ebstien Barr virus (EBV).
3. Enteroviruses.
4. Adenovirus.
5. Herpes zoster virus (HZV).

 Q64:  

A 16-year-old boy presents with a 4-day history of fever, headache, and confusion. Further workup disclosed a diagnosis of viral encephalitis.

All of the following viral agents causing encephalitides have a good prognosis in general, except?

1. La Crosse encephalitis viral .
2. California encephalitis virus.
3. Venezuelan equine encephalitis virus.
4. Eastern equine encephalitis virus.
5. Ebstein Barr virus.

 Q65:

A 21-year-old man presents with repeated generalized tonic clonic fits without

regaining consciousness. He is a known cause of epilepsy, and is taking phenytoin, but he stopped taking his medication since 1 week because he was seizure free for seven months and he thought that phenytoin is no more needed, as his roommate said.

Which one of the followings is true regarding status epilepticus?

1. It is not a medical emergency.
2. Intracranial hemorrhage is the commonest precipitating factor.
3. Phenobarbitone should be given immediately.
4. Lactic acidosis is seen.
5. Hypothermia is very common.

 

Q66:

A 34-year-old man presents with sudden onset of aphasia and right sided weakness. Brain CT scan revealed a large hypo-dense area consistent with occlusion of the main stem of the left middle cerebral artery.

Ischemic stroke in young people is an important subject in neurology. Which one of the followings is true regarding the investigations done to discover the cause of this topic?

1. Tranesophageal Echocardiography is not indicated.
2. ECG would probably add nothing.
3. VDRL can be useful.
4. CSF analysis is useless.
5. Anti-phospholipid antibodies are ordered in old people only.

 

 Q67:

A 24-year-old woman, who was completely healthy and reasonably well, presented with sudden severe headache and dense left sided weakness. An urgent non-contrast brain CT scan revealed a small hematoma at the right basal ganglia.

Which one is the wrong statement regarding her illness?

1. Spontaneous hypertensive hemorrhage is the likely etiology.
2. Toxicology screen should be done.
3. Conventional cerebral angiography can be useful.
4. Coagulopathies should be excluded.
5. Congophilic angiopathy is a not a consideration.

 
Q68:

A 34-year-old man presents with 3-week history of abnormal jerky movements involving his left hand only, which start and stop suddenly and spontaneously.

Which one of the followings is true regarding his illness?

1. Brain CT scan is diagnostic.
2. A history of head trauma is irrelevant.
3. Primary brain tumors are not a consideration.
4. A history of migraine like headache is important.
5. Carbamazepine is probably not effective.

 
Q69:

A 63-year-old man presented with an acute onset of right sided weakness and motor aphasia. He is hypertensive and diabetic. Brain CT scan is consistent with cerebral infarction.

Regarding antiplatelets and anticoagulation use in acute ischemic stroke, which one is the correct statement?

1. Aspirin has been shown to decrease early stroke recurrence.
2. Aspirin had not been shown to decrease stroke related morbidity.
3. Heparin should be given in all acute cases.
4. Heparin is not associated with increased risk of CNS hemorrhage.
5. Clopidogrel should be combined with aspirin routinely.

 Q70:

A 54-year-old woman presents with few weeks history of painful proximal muscle weakness. Her CK is markedly elevated, and EMG is of myopathic pattern. A provisional diagnosis of polymyositis is done.

Which one is the correct statement regarding this inflammatory myopahty?

1. Severe facial weakness is usually seen.
2. Absence of ocular involvement should cast a doubt on the diagnosis.
3. Anterior neck muscle involvement is unusual.
4. Respiratory muscles involvement may be seen.
5. A skin rash should be present to fulfill the diagnosis.

 
Q71:

A 6-year-old boy presents with progressive gait unsteadiness and right hand clumsiness. His mother said that he frequently vomits in the morning. Brain MRI discloses a right sided cerebellar hemispheric mass. Which one is the correct statement regarding cerebellar tumors in children?

a. Infratentorial tumors tend to raise the intracranial pressure lately.

b. High grade malignant gliomas are the commonest type.

c. A cerebellar pilocytic astrocytoma has an excellent prognosis.

d. Neck stiffness indicates the occurrence of subarachnoid hemorrhage.

e. Brainstem compression never occurs

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