Monday, 2 November 2015

Frequently Asked Neurology Objective Type Questions And Answers

91- A 47-year-old man presents with memory impairment worsening over 9 months. He has jerking movements of his limbs and biphasic high-amplitude sharp waves on EEG. Which diagnosis is most likely? 
1) Alzheimer's disease
2) Creutzfeld-Jakob disease
3) Multi-infarct dementia
4) Normal Pressure Hydrocephalus
5) Pick's disease

92- A 72-year-old woman has a five year history of worsening mental functioning with trouble remembering things. She has no problems with movement. She is noted on an MRI scan of the brain to have symmetrically increased size of the lateral ventricles along with cerebral cortical atrophy in a mainly frontal and parietal distribution. A lumbar puncture reveals a normal opening pressure, and analysis of the clear, colorless cerebrospinal fluid reveals a glucose and protein which are in
normal ranges. Cell count on the CSF shows 3 WBCs (all lymphocytes) and 1 RBC. A fundoscopic examination is normal. Which of the following findings is most likely associated with her underlying disease process?
1) Increased numbers of Lewy bodies
2) Loss of Betz cells
3) Loss of gamma aminobutyric acid (GABA)
4) Perivascular mononuclear inflammation
5) Presence of the e4 allele of apolipoprotein E

93- A 60-year-old man was brought to casualty after a fall in his bathroom. Seen immediately by his family, he was already picking himself up from the floor and said he was not injured. His wife felt that he was transiently dazed. On examination, he was alert, and no abnormalities were noted. His past medical history included a history of hypertension for which he was taking bendrofluazide 2.5 mg daily. He was discharged without any further intervention. Two weeks later his wife brings the patient to see you because the dazed state has returned. Examination reveals a temperature of 36.7C, a pulse rate of 84 bpm regular, a blood pressure of 152/94 mm Hg. On questioning he is slightly slowed, being disoriented to time with some deficit in recent memory.
The patient moves slowly, but power is normal. Neurologic examination shows slight hyperactivity of the tendon reflexes on the right with unclear plantar responses because of bilateral withdrawal. 
Which of the following would you request?
1) 24-hour ambulatory electrocardiogram
2) CSF analysis
3) CT of the head
4) Electromyography and nerve conduction testing
5) EEG

94- Which of the following forms of encephalitis is caused by a neuroimmunological response?
1) Herpes simplex
2) Measles
3) HIV infection
4) Enteral viruses
5) Cytomegalovirus

95- A 60-year-old woman presents with a 24 hours history of headache and vomiting. She has been on steroids for temporal arteritis for the last 3 years. Examination demonstrates pyrexia, neck stiffness, photophobia, dysarthria, nystagmus and ataxia. CSF shows neutrophilic pleocytosis, low glucose, elevated protein. What is the most likely diagnosis?
1) Carcinomatosis meningitis
2) Cryptococcal meningitis
3) Listeria meningitis
4) Meningococcal meningitis
5) Tuberculus meningitis

96- In which of the following is mental retardation an expected finding?
1) Alkaptonuria
2) Cystinuria
3) Glycogen storage disease
4) Lactose intolerance
5) Maple syrup urine disease

97- Which of the following is correct regarding Herpes simplex encephalitis?
1) shows a peak incidence in the Autumn
2) is associated with a polymorphonuclear pleocytosis in the CSF
3) produces a diffuse, evenly distributed inflammation of cerebral tissues
4) produces a typical EEG pattern with lateralised periodic discharges at 2 Hz
5) should be treated with acyclovir as soon as the diagnosis is confirmed by urgent CSF viral antibody titres

98- A 73-year-old man presents with an abrupt onset of double vision and left leg weakness. Examination shows weakness of abduction of the right eye, right-sided facial weakness affecting upper and lower parts of the face. He also has a left hemiparesis. Where is the lesion?
1) left frontal lobe
2) left lateral medulla
3) right corpus striatum
4) right midbrain
5) right pons

99- Which of the following statements regarding hiccup is true?
1) Is caused by a tonic relaxation of the diaphragm.
2) May be caused by local irritation to the vagus nerve.
3) Can reliably be treated with theophylline.
4) May be caused by a posterior fossa tumour.
5) May be caused by a foreign body in the nose.

100- In considering the management of convulsions select the correct statement from the list below.
1) If the fit lasts longer than 5 minutes, then PR diazepam should be given.
2) Phenobarbitone is a useful therapy in school age children.
3) Paraldehyde is best given intramuscularly.
4) Hypoglycaemia should always be considered.
5) When associated with fever, antibiotics should always be given to cover the possibility of meningitis.

101- The action of noradrenaline released at sympathetic nerve endings is terminated by
1) enzymatic decarboxylation
2) enzymatic inactivation by catechol-O-methyl transferase
3) re-uptake of noradrenaline by the axonal terminals
4) oxidative deamination by monoamine oxidase
5) Removal by the circulating blood

102- A 65 year-old woman with 12 hour history of unsteady gait, sudden onset associated with vomiting and headache. Following this she had increasing drowsiness. What is the diagnosis?
1) Acute subdural haemorrhage
2) Cerebellar haemorrhage.
3) Frontal subdural empyema
4) Herpes simplex encephalitis.
5) Pituitary apoplexy.

103- A 18-year-old female presents with a 3 days history of progressive weakness and numbness of her legs, urinary retention and back pain 2 weeks following an upper respiratory infection. On examination there is spastic paraparesis, sensory level up to T5, extensor plantars. Examination of cranial nerves and upper limbs is normal. MRI of the spine is normal. The most likely diagnosis is:
1) Multiple sclerosis
2) Anterior spinal artery occlusion
3) Post-infectious transverse myelitis
4) Thoracic disc prolapse
5) Guillain Barre syndrome

104- A 40-year-old man with a long history of alcohol abuse is admitted with a subacute illness, comprising headache, fever, meningism and ataxia. MRI brain showed patchy high signal abnormality of the brain stem. CSF analysis showed polymphonuclear pleocytosis and low glucose. He had failed to improve after 3 days of intravenous cefotaxime treatment. The most likely diagnosis of the meningitis is:
1) Mycobacterium tuberculosis
2) Cryptococcus neoformans
3) Nocardia asteroides
4) Staphyloccus aureus
5) Listeria monocytogenes

105- A 27-year-old man presents with a two years history of intermittent tingling sensation involving his left side. It starts in his fingers and spreads in 10-20 seconds to affect the whole arm and leg on the same side. The attacks only last for one minute. The most likely diagnosis is:
1) Migraine with aura
2) Transient ischaemic attacks
3) Somatosensory seizures
4) Hyperventilation
5) Multiple sclerosis

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