MCQ

1
MCQ1

• Which of the following can be initial
  neurological manifestations of sarcoidosis?
•  
• a.              Bells palsy
• b.              Diabetes insipidis
• c.               Ophthalmoplegia
• d.              Peripheral neuropathy
• e.              Any of the above

2

• Resp e
• Sarcoidosis can affect
• both CNS PNS
• focally difusely
• Sarcoidosis is not the commonest cause of any of
  them.. Think about it if more than one
  manifestation

3

• Benign positional vertigo is one of the most
  common causes of dizziness. Which of the
  following are true for this disorder ?
• a. Change of position exacerbates vertigo
• b. Symptoms are worse later in the day
• c. Duration of evoked nystagmus is usually less
  than 30 seconds
• d. Vertigo persists with successive movements
• e. Is most likely due to vestibular neuropathy

4

• Resp. a c
• Position change exacerbate the vertigo
• Essentially, without movements, symptomes are
  minimal
• D 3 30 secondes
• The vertigo
• is worse in the morning
• Becomes better with more provocative movements

5

• MCQ3-2
•  
• Internuclear ophthalmoplegia is characterized by
  all of the following except
• a. Medial rectus palsy may produce similar
  clinical findings
• b. Skew deviation can develop in patients with
  INO
• c. The lesion is in the MLF ipsilateral to the
  side of the adduction weakness
• d.  Most patients with INO complain of vertical
  diplopia
• e.  Vertical pursuit is impaired in most patients
  with INO

6

• Resp d
• Most patients with INO do not complain of
  diplopia
• If they do horizontal diplpia is the most
  common
• All the other resp are true
• Vertical poursuit is commonly affected the MLF
  carries information regarding vertical gaze
  lateral gaze.
• Skew deviation can develop in some patients

7

• MCQ4
•  
• (1) Monocular visual loss with optic disc
  swelling is suggestive of
• a.              Optic neuritis
• b.              Hyperviscosity syndrome
• c.               Diabetic papillopathy
• d.              Malignant hypertensin
• e.              Peri-chiasmatic tumor
•  
• 2) The most likely diagnosis in case of bilateral
  visual loss with papilloedema and encephalopathy?

8

• Resp 1 a
• 2 d
• Optic neuritis classically ? visual loss
  (intrabulbar, papillitis) optic n. swelling
• In retrobulbar no optic n. swelling
• Malignant HTN ? papilledema /- visual loss

9

• MCQ5-1
• A 70-year-old right-handed man with stroke
  resulting in left hemiparesis has two episodes of
  falls.
• 1st A prolonged period of somnolence confusion
  followed the fall.The possible raison are
•  
• a.   Recurrent TIA
• b.   Another CVA
• c.   Seizure secondary to the first CVA
• d.   Simple fall associated with poor
  coordination
• e. Cardiac arrhythmia with decreased cerebral
• perfusion

10

• a.  Recurrent TIA
• b.   Another CVA
• c.   Seizure secondary to the first CVA
• d.   Simple fall associated with poor
  coordination
• e. Cardiac arrhythmia with decreased cerebral
  perfusion
• 2d Presyncopal sensation and diaphoresis
  preceding the fall, with no sequelae.
• 3d  Patient is noted to have a transient
  worsening of his left hemiparesis after one of
  the falls and to be unable to speak after.

11

• Resp. 1st c
• 2d e
• 3d a
• The seizure is the most likely if the patient has
  prolonged somnolence confusion.
• Cardiac arrythmia is most likely to produce
  presyncopal attack. Lack of sequelae after the
  fall would argue against TIA/CVA
• TIA is most likely with neuro deficit. Todd
  phenomena is unlikely if there are no
  tonic/clonic manifestations.

12

• MCQ6
•  
• Clinical assessment of patients being treated for
  inflammatory myopathy is key, but which of the
  following laboratory tests is best for following
  patients during the treatment regimen ?
•  
• a.     CK
• b.    EMG
• c.  Muscle biopsy
• d. None of these are helpful

13

• Resp. a
• CPK is the most helpful for the assessement of
  myositis during treatment
• It ? if weakness improve
• ? CPK ? weakness exacerbation
• EMG is not usually helpful to differentiate the
  disease from drug induced (steroid) myopathy
• Please try to avoid requesting EMG routinely in
  this situations