Monday, 2 November 2015

Neurology Multiple Choice Questions And Answers

31- A 25-year-old female presents with 2 days history of diplopia and unsteadiness. 2 weeks ago she suffered an upper respiratory tract infection. On examination there is complete opthalmoplegia, areflexia and gait ataxia. Which of the following blood tests is the most likely to confirm the underlying diagnosis?
1) Acetylcholine receptors antibodies
2) Anti GM1 antibodies
3) Anti GQib antibodies
4) Anti Hu antibodies
5) Anti purkinje cell antibodies

32- Which of the following is true of tetanus?
1) failure to culture Clostridium tetani from the wound would make the diagnosis doubtful
2) infection confers lifelong immunity
3) there is a characteristic EEG
4) Clostridium-specific intravenous immunoglobulin is of no benefit once spasm has started
5) cephalic tetanus causes severe dysphagia

33- A 68-year-old man presents with progressive visual impairment. On examination there is an incongruous homonymous hemianopia. The most likely anatomical site of the neurological lesion is at:
1) optic nerve
2) optic tract
3) chiasma
4) optic radiation
5) occipital lobe

34- A 21 year old female with epilepsy is well controlled on sodium valproate 600mg bd and had been taking oral contraceptives for three years. She presented to her general practitioner 12 weeks pregnant. Which of the following is correct?
1) An alternative anticonvulsant should be used in place of sodium valproate
2) Interaction of sodium valproate with the oral contraceptive increased the risk of pregnancy
3) The dose of sodium valproate should be increased
4) There is an increased risk of a neural tube defect in her fetus
5) She is at increased risk of anaemia in pregnancy

35- A 40-year-old man has had decreased mentation with confusion as well as increasing incoordination and loss of movement in his right arm over the past 6 weeks. An MRI scan shows 0.5 to 1.5 cm lesions in cerebral hemispheres in white matter and at the grey-white junction that suggest demyelination. A stereotatic biopsy is performed, and immunohistochemical staining of the tissue reveals JC papovavirus in oligodendrocytes. Which of the following laboratory test findings is most
likely to be associated with these findings?
1) CD4 lymphocyte count of 90/microliter
2) Haemoglobin A1c of 9.8%
3) HDL cholesterol of 0.7 mmol/L
4) Oligoclonal bands in CSF
5) Serum sodium of 110 mmol/L

36- A 60-year-old man presents with an episode of memory loss. Three days earlier he had become confused. His wife led him into the house - he apparently sat down at her request, and had a cup of tea. He then wandered around the house, confused, but remained conscious and able to have some conversation with his wife, though continuing to ask similar questions repeatedly. After three hours, he abruptly returned to normal and had no recollection of the events. What is the most likely
1) alcohol related amnesia
2) chronic subdural haematoma
3) complex partial status epilepticus
4) hysterical fugue state
5) transient global amnesia

37- A 65-year-old man presents with 4 months history of swallowing difficulties (worse with liquids than solids). He also complains of nasal regurgitation, coughing and choking episodes during meals and slight dysarthria. He lost 1 stone over the last 8 weeks. Which of the following investigations is the most appropriate for this case?
1) Gastroscopy
2) Barium swallow
3) CXR
4) Tumour markers
5) Acetyl choline receptors antibodies

38 - A complete unilateral facial hemiparesis may be caused by which of the following?
1) An intracranial tumour
2) Birth injury
3) Cerebellar atrophy
4) Myasthenia gravis
5) Phenothiazine toxicity

39- Regarding pseudotumours cerebri (benign hypercranial hypertension) which is true?
1) A mildly increased CSF cell count is typical.
2) May be caused by prolonged steriod therapy.
3) Is occasionally associated with focal neurological signs.
4) Frequently presents with ataxia.
5) Is distinguished from hydrocephalus by the absence of suture separation.

40- Which of the following associations is correct?
1) Renal transplantation and Non-Hodgkin's lymphoma
2) Hepatitis B and aplastic anaemia
3) Turner's syndrome and acute myeloid leukaemia
4) Basophilia and chronic myeloid leukaemia
5) Crohn's disease and TB

41- A demyelinating polyneuropathy is typically caused by:
1) Diabetes
2) Excessive alcohol
3) Hereditary motor-sensory neuropathy
4) Renal failure
5) Vitamin B12 deficiency

42- Causes of dilated pupils include:
1) Argyll Robertson pupil
2) Ethylene glycol poisoning
3) Myotonic dystrophy
4) Organophosphate poisoning
5) Pontine haemorrhage

43- Which ONE of the following would be expected in a third nerve palsy?
1) Enophthalmos
2) Constricted pupil
3) Convergent strabismus
4) Increased lacrimation
5) Unreactive pupil to light

44- A 20-year-old female presents with acute onset of left foot drop. Examination reveals weakness of ankle dorsiflexion and eversion. There is a small area of sensory loss in the first web space. Reflexes were all present and plantars flexor. Which of the following nerves is likely to be involved?
1) Tibial nerve
2) Common peroneal nerve
3) Sciatic nerve
4) Femoral nerve
5) Inferior gluteal nerve

45- Which of the following is a characteristic feature of transient global amnesia?
1) abnormal behaviour
2) apraxia
3) confabulation
4) loss of personal identity
5) normal perception

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