"Best Of Five Questions For MRCP UK And Ireland Examinations" Dr. Osama Amin MBChB, MRCPUK part I,MRCPI part I ,MRCPI part II written Senior House Officer and 4th year student of the…..Board of Neurology. Dedication to The Republic Of Iraq and Iraqi Doctors all over the world. Q1 When facing with neurological investigations, all are true, except: 1- the predominant Rhythm of the EEG in a healthy young man is the alpha rhythm 2- the alpha rhythm on EEG disappears upon eye closure or mental thinking 3- the EEG is usually normal in 50% in the interictal phase of epileptics 4- the normal motor conduction velocity in the upper limbs is 50-60 meter/ second 5- the EMG is characteristically abnormal in metabolic myopathies
Answer 5 Remember, the word EEG does not mean Epilepsy, and EEG is not used in the diagnosis of Epilepsy although it is the most sensitive investigation in epilepsy …….so for more details …see neurology books. Metabolic myopathies usually have normal EMG e.g. in hypokalemic weakness, there are no characteristic changes on EMG testing.
Q2 When investigating the nervous system, all are wrong, except: 1-seeing the posterior cranial fossa is better with CT scan 2-MRI is poor in visualizing the white but not grey matter of the brain 3-the orbit is better seen by CT san 4-the MRI has an advantage of avoiding ionizing radiation 5-the carotid Doppler study has a very low inter observer variability
Answer: 4 1-false, many bone artifacts would interfere with the picture 2-false, both are excellently seen 3-false, MRI gives better details 4-true …..but should avoided in claustrophobic people 5-fasle, unfortunately, it is highly operator dependent
Q3 You are reading a report of a cerebro-spinal fluid analysis, all are true, except : 1-the normal opening pressure of CSF is 50-180 mm/H2O 2-the glucose is usually 30% that of the blood level 3-the protein is usually up to 45 mg /dl 4-single neurtophil is abnormal 5-oligoclonal bands should be absent
Answer :2 1-true..May be raised in many CNS diseases …however in many other diseases it might be normal even in the presence of profound CNS insult like NPH, MS..etc 2-false, usually 60-70% of the blood levels, levels below 50% are always abnormal 3-true above 50 mg /dl is abnormal 4-true, up to five cells is normal, all should be mononuclear 5-true, oligoclonal bands indicates intrathecal synthesis of IgG, and is seen in many CNS diseases (not only MS!!)
Q4 The urinary bladder may be involved in many central and peripheral neurological diseases, all are true, except: 1-the pelvic parasympathetic nerves stimulation causes bladder emptying 2-The L1 and L2 sympathetic outflow mediates bladder relaxation 3- S2, 3 and 4 sacral spinal cord lesions cause urinary retention as opposed to higher lesions which cause hyper excitable bladder 4-in acute spinal cord trans-section, urinary retention is rare, but urgency and frequency is much more common 5-neurogenic bladder in paraplegics is at a risk of future development of urinary bladder cancer
Answer 4 1-hence anticholenergics are given in upper motor neuron lesion to dampen the bladder. 2-and alpha blockers cause retrograde ejaculation 3-true ….. 4-the reverse is true, in acute lesions, retention is seen early to be followed gradually by urgency and frequency of micturition 5-true, usually squamous in type
Q5 The following field defects correspond to their matched statement, except one is wrong, which one is wrong: 1-pappilodema -enlargement of the physiological blind spot 2-tubal vision –conversion disorders 3-biteporal hemianopia –chraniopharyngioma 4-severe central scotoma –totally normally appearing disc 5-centrocecal scotoma – chronic simple glaucoma
Answer :2 Unlike the common belief; visual fields are actually detected much BETTER by a neurologist rather than by an ophthalmologist (who orders formal perimetry and doesn't know how to detect them by his own!!!!) Any how, visual field defects are common in clinical neurology: 1-true and with later constriction of the peripheral field. Remember: any pappillodema with severe visual impairment then it is NOT pappilodema , it is BILATERAL papillitis !!!!! So be careful !!! 2-true...tubal vision and tunnel visions are not the SAME ……tubal vision : the visual field remains with the same constriction as we go farther from the patient , but in the Tunnel vision , it improves as we move away from the patient ( just imagine looking from inside a tube and then inside a tunnel !! they are different ) tubal vsion is seen in hysterical reactions while tunnel vision is seen in chronic glaucoma. 3-ie a chiasmal lesion …….Also a chiasmal lesion may cause a junctional scotoma. 4-may be retrobulbar neuritis e.g. MS???!! In these cases, the patient sees NOTHING and you see NOTHING abnormal also!!!! 5-relatively early chronic simple glaucoma.
Q6 A patient presented with an impaired facial sensation , all are true causes ,except : 1-disease in one cavernous sinus 2-cellebo pontine angle meningioma 3-leasion in the upper cervical cord 4-a small lesion in the posterior limb of the internal capsule 5-idiopathic trigeminal neuralgia
Answer :5 Facial sensation is usually badly examined in clinical neurology, you should always be efficient in it, as it may reflect and localize many CNS diseases. 1-V1 and V2 branches of the trigeminal nerve might be affected 2-and others CP Angle lesions as in acoustic neuroma, here loss of corneal reflex is an early feature, so use it as a screening tool!! 3-C2 nerve supplies the angle of mandible, still a facial area!!! 4-true…but with a hemisensory loss in the limbs(eg pure sensory lacunar stroke) 5-keep it in mind: any neurological abnormality found on examination e.g. facial anesthesia, then it is not an idiopathic trigeminal neuralgia .
Q7 Features of pseudobulbar palsy, all are true, except : 1-dysarhtria 2-dysphagia 3-emotional lability 4-wasting and fasciculation of the tongue 5-exaggerated jaw jerk
Answer 4 Those who don’t practice neurology thinks that this condition is rare, no it is not , it is commonly seen in clinical neurology and has many causes like bilateral hemispheric strokes , upper brain stem lesions etc… 1-spastic Donald duck speech (as if the patient tries to speak from the back of the mouth) 2-oropharyngeal type...i.e. with regurgitation, chocking, coughing 3-true, very characteristic if you see it once 4-FALSE, small spastic conical one 5-true ….
Q8 You have been called to see a man and to give your opinion about brain death. The followings should be excluded before saying it is a brain death, which one is the wrong statement: 1-severe hypotension 2-barbiturate poisoning 3-core body temperature 30 C 4-neuromuscular blocking agents overuse 5-he is on a ventilator
Answer 5 Many conditions can MIMIC brain death clinically upon examination and without excluding them; you will KILL a person legally despite the reversibility of brain damage. These are: Profound shock, sedatives drug intoxication, hypothermia (core body temperature below 32 C) and neuromuscular blockade use .Children usually resist brain damage better than adults for the same degree of insult, so give them a chance and be extremely careful when diagnosing brain death in a child less than 5 years old. Don’t think that the diagnosis of brain death is an easy task (seems very easy when read in textbooks), it is a terrible responsibility, legally, ethically and medically.
Q9 A 30 year old patient came to you with headache, you diagnosed a frontal lobe tumor: all a of the followings can occur in this frontal lobe lesion, except : 1-positive grasp reflex 2-depression 3-disinhibition 4-imapirement of urination 5-olfactory hallucinations
Answer: 5 Remember: the frontal lobes have many functions, motor, behavioral, personality urination, praxis...etc Olfactory hallucinations are seen in temporal lobe lesions ………..the frontal lobe is close to the nose and olfactory nerves but has nothing to do with olfaction !!!
Q10 A 45 year old female came to see you because of feeling dizzy with vertigo, all of the followings in her evaluation are wrong, except: 1-the presence of horner syndrome may be of value 2-the absence of nystagmus excludes viral labyrinthinitis 3-severe vertigo is in favor central cause rather than peripheral cause of vestibulopathy 4-temporal lobe epilepsy is not a consideration 5-the presence of a co-existent hearing impairment favors a central cause
Answer 1 1-true ,may indicate a brainstem lesion like Wallenberg's lateral medullary syndrome. 2-fasle, a prominent feature 3-fasle, central one is usually mild although it is continuous. 4-fasle, a differential diagnosis if the vertigo is extremely episodic 5-fasle, peripheral, usually internal ear pathology
Q11 You are sitting at your clinic and you are watching a patient entering the examination room with a strange gait , all of the followings about gait is true ,except : 1-circumduction of a leg is seen in pyramidal weakness. 2-high stepping gait is seen in foot drop 3-imapired tandem walk could be due to cerebellar lesion 4-dipping on one side while walking may suggest a painful lower limb lesion 5-waddling gait is suggestive of peripheral neuropathy
Answer 5 You should always look at the patient while entering your room as his gait may SAY a lot of things while the patient cant talk at all .Gait abnormalities are very common in neurology , and a patient may be on a wheel chair HIDING his abnormal gait . So waddling gait is suggestive proximal myopathy including osteomalacia and rarely bilateral long standing congenital hip dislocation.
Q12 A 55 year old woman came to see you complaining of severe episodic facial pain , you diagnosed trigeminal neuralgia , all of the followings are wrong about her illness, except: 1-pain usually lasts for many hours 2-there is absent corneal reflex 3-the illness is usually seen in young males 4-the response is usually favorable to anticonvulsants 5-when bilateral or alternating, this excludes multiple sclerosis
Answer 4 1-the patients usually describes the pain as if it is of many hours duration, actually speaking , it is lancinating in seconds only but the rapid repetition of many episodes with in a short period gives a false impression of many hours duration 2-the neurological examination, apart from certain triggering ZONES, should be normal. 3-usually middle aged and elderly females 4-true, carbamazepine is very effective 5-MS must be excluded here
Q13 During cranial nerves examination of a patient, you noticed fasciculation of the tongue, all of the followings are causes of this phenomenon, except : 1-motor neuron disease 2-Paget disease of the skull 3-nasopharyngeal carcinoma 4-syringobulbia 5-bilateral hemispheric strokes
Answer 5 Pseudobulbar palsy is an upper motor neuron lesion including affection of the tongue muscles, the tongue is small conical and spastic with NO fasciculation. All others cause lower motor neuron lesion of the 12th cranial nerve
Q14 A patient came to see you with her boy friend because of attacks of loss of consciousness with abnormal jerking movements seen by her boyfriend. You diagnosed Epilepsy; all are wrong statements, except one: 1-in the EEG examination paper, the presence of sharp waves will add nothing to the overall diagnosis as it is seen in many other conditions and even normal people 2-you told her that all seizures must be medically treated after the first episode. 3-the life time risk of developing a single seizure is 10% 4-you told her that sleep deprivation and mental exhaustion are not precipitating factors for seizure provocation. 5-you told her that up to 70% of patients will develop a second seizure with in a year after the first one
Answer 5 1-FALSE, sharp waves are highly specific in the appropriate clinical settings with a false positive rate of 1/1000 2-fasle, only in highly selected patients e.g. brain tumors with one attack of seizure there is a place to start PROPHYLACTIC anticonvulsants as the pathology and the etiology is obvious .Otherwise wait for second and recurrent attacks ( which is the definition of EPILEPSY ) 4-false, prominent ones 5-TRUE …so follow up is very important in this period with proper education is given.
Q15 15 year old male brought to you by his parents with attacks of loss of consciousness with jerking movement and variable confusion afterwards .He has a family history of epilepsyand the neurological examination was normal .You diagnosed a generalized Grand Mal epilepsy . All of the followings are true, except: 1-he does not need hospital admission for further assessment 2-the presence of his parents as an eye witness is very important in the diagnosis 3-valproate is an excellent first line agent 4-tounge biting goes with the clinical picture 5-CT scan is a useful initial investigation
Answer 5 1-true, he can be seen and investigated as an outpatient ,only in highly selected patients hospitalization is needed for assessment e.g. presentation with status epilepticus or the need for certain inpatient investigations. 2-one of the corner stones in the diagnosis, yours or others eyes!! 3-true, effective and safe 4-but urination during the attack is not that specific 5-FALSE, his picture is a typical of idiopathic generalized grand mal epilepsy .Imaging studies are done when the clinical picture is suggestive e.g. focal features of the fits, abnormal neurological examination.
Q16 In temporal lobe epilepsy, all are true, except: 1-hallucination of smell and taste 2-in the so called complex attacks, consciousness is impaired but not lost totally as in generalized tonic clonic ones 3-here may be sense of extreme unfamiliarity with the surroundings 4-in clear cut cases, loss of consciousness is an indication of secondary generalization 5-Todd’s paralysis is seen
Answer 5 1-and of hearing or vision, usually well formed ones 2-and in “simple” ones, there is no impairment at all 3-or undue familiarity 4-true ……you should always think of secondary generalization 5-FALSE suggest focal motor epilepsy of the motor cortex in the frontal lobe.
Q17 A brain tumor patient came to see you for a scheduled follow up, you found a an elevated congested optic discs bilaterally .it is a pappillodema, all of the followings about this sign is true, except: 1-severe visual impairment is not seen early in the course 2-you found pain and tenderness of the globe which are commonly seen. 3-some patients might have unilateral swollen disc 4-in rapidly progressive cases, peripappillary hemorrhages are seen 5-this sign reflects raised intracranial pressure
Answer 2 1-true, early there is an enlargement of the physiological blind spot which almost always asymptomatic. Severe impairment of vision here indicates a co-existent pathology or it is actually a bilateral pappillitis (not a pappillodema). 2-FALSE suggests an alternative diagnosis like optic neuritis 3-with contralateral optic atrophy in Foster Kennedy Syndrome 4-true, may indicate a rapidly progressing process 5-true …there may be other signs also like bradycardia and hypertension
Q18 In ischemic stroke, all are true, except: 1-ischmic stroke comprises 80-85% of all strokes 2-the majority of ischemic strokes usually completed by 6 hours with an irreversible neuronal damage 3-long term aspirin after an ischemic stroke has been shown to reduce the incidence of death and subsequent strokes by 25% 4-early mortality is higher in hemorrhagic strokes 5-cardiogenic emboli responsible for up to 50% of cerebral infarctions
Answer: 5 1-true…a large percentage 2-unfortunately 3-a good percentage 4-true………but the long term prognosis is better than that of ischemic stroke 5-false up 20 %, other 20% is the lacunar type
Q19 Features suggestive of brainstem infarction, all are true, except: 1-pinpoint pupils 2-diplopia 3-headache 4-bidirectional nystagmus 5-congugate gaze palsy
Answer 3 Headache may be seen in supra as well as infratentorial strokes.
Q20 Tuberculous meningitis, all are true, except: 1- a thick yellowish green exudate is seen mainly at the basal cisterns 2- cranial nerves palsies are seen in 25 % at the time of diagnosis 3- may be part of military TB 4- early there may be a neutrophilic meningitis 5- 95% of cases may present as an acute meningitis like picture
answer 5 1-true which results in prominent basal meningitis and cranial nerve palsies and hydrocephalus. 2-usually the 6th and which may be bilateral 3-yes .but sometimes no evidence of chest or military TB 4-true …….and also after starting steroids, in which the CSF cells become mainly neutrophilic, which is highly characteristic in the appropriate clinical settings 5-false ,up 25 % may be present explosively like pyogenic meningitis and even the CSF study is suggestive of pyogenic cause
Q21 Functional recovery of a patient who had sustained a stroke , all are true , except: 1-non dominant hemispheric lesions portend a bad prognosis 2-profound and prolonged coma is a very bad sign 3-large hemorragic strokes per se carry a poor early prognosis 4-severe headache 5-persistent gaze preference and gaze palsies answer 4 Functional recovery following strokes is an important part to predict the course of the illness and patient's education and management. -Coma per se if deep and more than 24 hours carry a very bad prognosis -non dominant hemispheric lesions have a poor functional outcome . -associated hypertension if severe is also another poor factor -brain stem strokes usually devastating as many structures are PACKED closely.
Q22 Viral encephalitis in general, all are true, except: 1-usualy there is somewhat acute onset of a headache and fever 2-the CSF sugar is usually normal 3-neck stiffness is seen up to 75 % of cases 4-most encephalitides carry good long term outcome 5-the commonest cause of sporadic viral encephalitis is herpes simplex virus
Answer 4 1-true, usually presents with out a prodromal phase, even in a stroke like picture 2-with raised protein 3-true some element of meningitis is usually seen, hence the precise term menino-encephalitis 4-false, unfortunately few have good prognosis, but the majority have high morbidity and mortality. 5-true ……….no seasonal variation
Q23 Epidemiology of multiple sclerosis, all are true, except: 1- Many HLA haplotypes might be associated 2- the incidence gradually rises as we move from the equator towards the poles 3- slight females preponderance 4- mainly targets the grey matter 5- juvenile cases are uncommon
Answer: 4 1-like HLA DR2 and DW2,A3,B7 2-suggesting a strong environmental factor 3-true 4-fasle, strong white matter preference 5-true .
Q24 In Multiple sclerosis, all are true, except: 1-siezures are rare at the time of diagnosis and prominent ones suggest another diagnosis. 2-demntia may occur in the long term 3-bilateral optic atrophy with spastic paraplegia may be a clue to the diagnosis 4-CSF protein usually in the range of 400-500 mg/dl 5-an acute hemiplegic type may be seen and usually difficult to differentiate from true stroke
Answer 4 MS has diverse clinical manifestations……..and should always be looked for in any STRANGE neurological disease. 1-true .but in the long term, sub cortical plaques may encroach upon the cortex and irritate it. 2-true ……of sub cortical type 3-true ……..dissemination in place 4-false usually 60-80 mg /dl .if it is above 100 mg/dl then look for another cause. 5-true...But very rare
Q25 Investigations used to diagnose multiple sclerosis , all are true ,except : 1-visual evoked potential may detect up 75% of clinically silent lesions 2-MRI is a useful tool 3-EEG changes are highly characteristic. 4-CSF oligoclonal bands are seen up to 70-90% of cases 5-EMG has no place
Answer: 3 Remember, MS has no diagnostic investigation ………… and all other investigations are used to support the CLINICAL diagnosis ……and clinical criteria are the most important in making the diagnosis. 1-the evoked potentials are useful to detect silent lesions to detect dissemination in place 2-to see CNS white matter lesions 3-no place at all 4-but many diseases can cause oligoclonal bands 5-true ….although poor recruitment might be seen due to the pyramidal weakness
Q26 During making a diagnosis of idiopathic Parkinson’s disease in 56 year old male, the followings are not consistent with the diagnosis, except : 1-unilateral or asymmetrical tremor early in the disease 2-prominent emotional lability 3-exaggerated deep tendon reflexes with an ankle clonus 4-imapired down gaze 5-bilateral extensor planters
Answer 1 1-idiopathic Parkinson’s disease, usually asymmetrical or unilateral to start with ………..pure bilateral symmetrical onset is highly atypical 2-against the diagnosis 3-it is a basal ganglia pathological process, not a pyramidal 4-? Supra nuclear palsy 5-never an expected finding in idiopathic Parkinson's disease…………..
Q27 Motor neuron disease, all are true, except: 1-the disease usually stars above the age of 50 years, but no age is exempt 2-a variable combination of upper and lower motor neuron lesions 3-bulbar onset portends a grave prognosis 4-the pace is usually insidious 5-drug therapy is effective at slowing the pace of the illness
Answer :5 MND in general has a grave prognosis, most patients die within 2-6 years of the diagnosis .No drug therapy till now has been shown effectively to slow down the disease progression
Q28 Huntington’s disease, all are true, except: 1-Parkinsonian features are seen in certain varieties 2-epilepsy may be seen in certain varieties 3-100% fatal 4-is an autosomal recessive disease 5-prominent personality and behavioral disorders may be the presenting features
answer 4 1-true, adds confusion to picture 2-usually adolescents 3-true ………nothing can be done to stop the degeneration 4-AD with complete peniterance but with a late onset appearance 5-true...the chorea may be totally absent at presentation.
Q29 Spinal cord compression, all are true, except: 1-localized areas of pain and tenderness in the spine usually precede the full blown picture of cord compression in malignant causes 2-sensory changes are usually the first to start with 3-sphincteric abnormalities always indicate a late disease 4-primary spinal tumors are the commonest causes 5-CSF protein is usually very high Answer 4 1-true, hence it might be used as a screening tool to irradiate these areas before any catastrophe occurs 2-true, then motor 3-yes.after sensory and motor changes 4-false, uncommon causes, the majority of cases are due to extra dural extra medullary masses 5-true may reach 3 grams /dl(Froin's Syndrome)
Q30 Paraplegia, all are causes, except: 1-parasaggital meningioma 2-transverese myelitis at T6 level 3-spinal cord trans-section at the dorsal spine 4-acute anterior spinal artery occlusion at the dorsal spine 5-gun shot injury at the cauda equina
Answer :5 Paraplegia , means a lesion in the spinal cord or the brain ………so we usually start with examination of the lower limbs ,then the trunk and then the upper limbs and then ascend to see if there is any cranial nerve findings . 1-true as a well as superior saggittal sinus thromosis 2-like in MS 3-like a vertebral fracture dislocation 4-true, with dissociated sensory loss 5-FALSE flaccid asymmetrical weakness in both lower limbs
Q31 Hemi section of the spinal cord, all of the followings findings are true, except: 1-there is an ipsilateral up going toe below the level of the lesion 2-ipsilateral loss of vibration below the level of the lesion 3-ipsilateral loss of pain and temperature sensations below the level of the lesion 4-ipsilateral area of dysthesia on the trunk at the level of the lesion 5-ipsilateral lower motor neuron lesion at the level of the lesion
Answer 3 Contralateral loss of pain and temperature sensation 2-3 segments below the level of the lesion
Q32 Syringomyelia, all are true, except: 1-muscle wasting is usually asymmetrical to start with in both upper limbs 2-trophic changes are prominent in full blown picture 3-dissociated sensory loss 4-tongue involvement indicates lower brain stem involvement 5-usually it has a rapid progression
Answer 5 1-with loss of reflexes 2-and may cause ugly looking hands, also scars, burns . 3- Crude touch and vibration are intact to start with. 4-true, so called syringobulbia, but nystagmus may be seen in high cord lesions. 5-fasle, insidious disease
Q33 Dementias in general, all are true, except: 1-Alzheimer’s disease is the commonest cause 2-up to 20 % of people above the age of 80 years have some form of dementing illness 3-B12 deficiency is a potentially reversible cause 4-all patients will Down's syndrome will develop an Alzheimer’s type dementia by the age of 40 years. 5-prominent formed visual hallucinations are in favor of Picks type dementia
Answer :5 1-up 40% of cases 2-true and always exclude depression 3- Unfortunately, only 5 % of all cases of dementias are reversible 4-true .may be the abnormal; chromosome 21 per se is the cause 5-fasle suggests Lewy body dementia
Q34 Causes of proximal myopathy , all are true, except: 1-hypothyroisidm 2-chronic alcoholism 3-Cushing ‘s disease 4-osteomalacia 5-diabtes mellitus
Answer 5 1-and hyperthyroidsm which may cause also a bulbar weakness old people 2-usually with evidence of peripheral neuropathy 3-with type II fiber atrophy 4-look for Looser’s zones , measure Serum calcium and phosphate 5-false , may cause proximal amyotrophy , but not proximal symmetrical myopathy
Q35 Duchenne muscular dystrophy, all are true, except: 1-usually presents between the age of 3-5 years 2-there may be enlargement of the calves 3-the CPK is high even from birth 4-the commonest cause of death is cardiac problems 5-some metal abnormality is seen up to 20%
Answer 4 Duchenne gene, is the largest gene in the body . 1-true , up to 10 years is accepted 2-pseudohyperetrophy due to fibrofatty infiltration 3-usually very high .normal level is against the diagnosis 4-false , although cardiac involvement is common, it is rarely the cause of death, Common causes are :respiratory failure , aspiration and acute gastric dilatation 5-true …..many explanations were given , one of them suggests that dystrophin is present normally in brain but it s defective in those patients.
Q36 Management of myasthenia gravis , all are true ,except : 1-puppilary constriction in the context of profound life threatening weakness may be a clue to cholenergic crises 2-propantheline is usually given 3-6 times daily to combat the side effects of pyridostigmine 3-thymectomy is indicated in all cases 4-the presence of thymoma portends a poor prognosis 5-during a suspected myasthenic crisis , we should stop all medication if we can
Answer : 3 1-true …….a useful one , and tenslon test should be carried out to differentiate myasthenic from cholenergic crisis but should be done in the intensive care setting . 2-true , like abdominal cramps and diarrhea 3-fasle : not indicated in neonatal mythenia , pure ocular myasthenia , myasthenia for more than 7 years duration , congenital myasthenia , ? elderlies. 4-true as 33% are malignant , the prognosis is worse even when the tumor is completely removed 5-true , during any crisis , stop all medications and admit immediately to the ICU with assisted ventilation and diagnose the cause and treat as appropriate .
Q37 Guilllain Barre syndrome , all are true ,except : 1-usually preceded 1-4 weeks by an upper respiratory tract or GIT infection 2-pure axonal type is seen and carries a poor prognosis 3-20% will need mechanical ventilation 4-facial weakness is seen in 50% 5-dysautonomia is seen in 6 %
Answer: 5 1-preceding compylobacter infection portends a poor prognosis 2-true, but fortunately uncommon 3-true...you should follow up the patient, ask for dyspnea and measure the FVC regularly. 4-true, may be subtle 5-fasle …..Up to 65 %, which is not a small percentage and may result in a sudden cardiorespiratoy arrest.
Q38 Clues to peripheral neuropathy, all are true, except : 1-blood picture showing basophilic stippling 2-psychosis and abdominal pain 3-prominent postural hypo tension and nephrotic syndrome 4-hoarse voice–hyperthyroidism 5-painful burning feet
Answer 4 After through investigations, up to 1/3rd of all cases of peripheral neuropathy, no single cause will be found . 1-?lead poisoning 2-?acute intermittent porphyria ,so,measure urinary ALA and PBG during acute attacks 3-?diabetic autonomic neuropathy, irreversible and carries a poor prognosis as 50% will be dead after 10 years 4-false , hypothyroidism NOT hyperthyroidism may be the cause 5- ?alcoholism or amyloidosis(small fiber neuropathy)
Q39 Carpal tunnel syndrome, all are true, except: 1-may be diagnosed during pregnancy 2-pain, but not the parastheisias , may radiate up the arm 3-dibetes mellitus is a risk factor 4-up to 50 % the nerve conduction study and EMG are totally normal 5-the face of the patient may give a clue to the underlying cause of it .
Answer 4 1-or may be increased during pregnancy or oral contraceptives 2- even to the shoulders 3-true, 4-false,up to 5% ,due to certain variants in connection between the median and ulnar nerves, that is why the diagnosis is mainly clinical 5-? Acromegally, hypothyroidism.
Q40 Chronic subdural hematoma , all are true, except : 1-in 25-50 % of cases, no history of head trauma can be obtained 2-mainly seen in elderlies and alcoholics 3-after 4 weeks, the hematoma becomes darker than the brain 4-the source of bleeding is an arteriolar one 5-some hematomas gradually expands Answer 4 1-such a history is highly characteristic in elderlies. 2-due to smaller brain and stretching of the bridging veins 3-true may be very easily missed by CT scan especially if bilateral 4-false ,venous ,hence it is not RAPIDLY formed or explosive in nature after the start of the bleeding. 5-true and may fluctuate in size . NB.the classical description of a fluctuating level of consciousness of SDH is rare in clinical practice.
