Q33: Dementias in general, all of the followings are true, except: 1- Alzheimer’s disease is the commonest cause.. Subchapter: B Q1: Alzheimer's disease, which is the wrong statement?. Q
Trang 14- Primary spinal tumors are the commonest causes
5- CSF protein is usually very high
Q30: Paraplegia, all of the followings are true causes, except:
1- Parasaggittal meningioma
2- Transverse 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 equine
Q31: Hemi section of the spinal cord; all of the following findings are true, except:
1- ipsilateral up going toe at the side 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
Q32: Syringomyelia, all of the followings 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 very rapid progression
Q33: Dementias in general, all of the followings 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-Viotmain 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
Q34: Causes of proximal symmetrical myopathy, all of the followings are true, except:
1- Hypothyroidism
2- Chronic alcoholism
3- Cushing‘s disease
4- Osteomalacia
5- Diabetes mellitus
Q35: Duchenne muscular dystrophy, all of the followings are true, except:
1- Usually presents between the ages 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 mental abnormality is seen up to 20% of cases
Q36: Management of myasthenia gravis, all of the followings are true, except:
Trang 21-Puppilary constriction in the context of profound life threatening weakness may be
a clue to cholinergic 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
Q37: Guilllain Barre syndrome, all of the followings 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% of patients will need mechanical ventilation
4- Facial weakness is seen in 50% of cases
5- Dysautonomia is seen in 6% of cases
Q38: Clues to peripheral neuropathy, all of the followings are true, except:
1- Blood picture showing basophilic stippling- lead poisoning
2- Psychosis and abdominal pain- acute intermittent porphyria
3- Prominent postural hypotension and nephrotic syndrome- primary AL amyloidosis 4- Hoarse voice–hyperthyroidism
5- Painful burning feet- alcoholism
Q39: Carpal tunnel syndrome, all of the followings are true, except:
1- May be diagnosed during pregnancy
2- Pain, but not parasthesias, may radiate up the arm
3- Diabetes mellitus is a risk factor
4- In up to 50% of cases 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
Q40: Chronic subdural hematoma, all of the followings are true, except:
1- In 25-50% of cases, no history of head trauma can be obtained
2- Mainly seen in elderly people 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 expand
Subchapter: B
Q1: Alzheimer's disease, which is the wrong statement?
a- it is the commonest cause of dementia with a prevalence of 10-20 million cases world wide
b- men and women are affected with equal frequency
c- abnormal metabolism and deposition of beta-amyloid protein appears to be closed linked to its pathogenesis
d- it is usually inherited on genetic basis
e- neuropathologically, there are neuritic plaques and neurofibrillary tangles
Q2: Alzheimer's disease, which is the wrong statement?
a- patients with Down's syndrome have a very high incidence of developing
Alzheimer's disease
Trang 3b- familial Alzheimer's diseases are autosomal dominant linked to chromosomes 1 and 14
c-the number of APOE4 allels on chromosome 19 may influence the disease
development
d- abnormal cleavage of amyloid precursor protein (APP) by alpha, beta and gamma secretases is one of the presumed pathophysiological mechanisms
e- choline acyltransferase is markedly increased in the cortex and hippocampus of patients with Alzheimer's disease
Q3: Alzheimer's disease, which is the wrong statement?
a- there is prominent degeneration of the nucleus basalis of Meynert and of
cholinergic septal-hippocampal tract
b- APOE4 polymorphism increases the susceptibility to Alzheimer's disease
c- various missense mutations in APP gene on chromosome 21 may cause familial Alzhiemer's disease
d- various missense mutations in PS2 gene in chromosome 1 is responsible for the development of early onset Alzheimer's disease in Volga Germans
e- Down's syndrome patients are protect against the development of Alzheimer's disease
Q4: Early manifestation of Alzheimer's disease, which is the wrong statement?
a- impairment of recent memory is typically the first sign of the disease
b- gradually the patient becomes disoriented to time
c- aphasia , anomia and acalculia are very rare
d-a frontal gait disorder may be seen early
e- visuo-spatial disorientation can be seen early in the course
Q5: Late manifestation of Alzheimer's disease, which is the wrong statement?
a- seizures occur in some cases
b- there might be frank psychosis with paranoia and hallucinations
c- rigidity and bradykinesia are late features
d- mutisim, incontinence and bed-ridden state indicate a terminal situation
e- death typically occurs 1-2 years after the onset of symtoms
Q6: Medical treatment of Alzheimer's disease, which is the wrong statement?
a- nowadays, there are many medications that can reverse or arrest the progression of the disease
b- acetyl cholinesterase inhibitors have been shown to produce small improvement in the tests if cognitive function
c-of all acetyl cholinesterase inhibitors, donepezil is now the agent of choice
d- alpha tocopherol and selegilin have been shown to be of small benefit in
Alzheimer's disease
e- behavioral disturbances can be controlled by antipsychotics, antidepressents or anxiolytics
Q7: Prognosis of Alzheimer's disease, which is the wrong statement?
a- early in the course, the patient can usually remain at home
b- in advanced cases ,the patient usually needs special care in a nursing facilities c- the patient should be protected from injuring himself and his family
d- death usually occurs 5-10 years after the onset of symptoms
Trang 4e- the usually cause of death is myocardial infarction.
Q8: Pick's frontotemproal dementia rather that Alzheimer's disease ,is suggested
by all of the followings except ?
a- earlier age of onset
b- more prominent behavioral than cognitive dysfunction at presentation
c- MRI showing preferential atrophy pf anterior temporal frontal lobes
d- the presence of Pick's cells and Pick's inclusion bodies on biopsy specimen
e- the presence of prominent neuritic plaques and neurofibrillary tangles
Q9: Creutzfeldt-Jacob disease, which is the wrong statement?
a- invariably fatal transmissible disorder of the central nervous system
b- the annual incidence is 1:1000000 population
c- the naturally acquired disease occurs in patients 16-82 years of age
d- affects both sexes equally
e- more thanone member of a family is affected in up to 90% of cases
Q10: Creutzfeldt-Jacob disease, which is the wrong statement?
a- transmission from humans to animals has been demonstrated
b-the infectious agent is present in all body fluids
c- familial cases are due to mutation in the prion protein-cellular isoform
d- the normal prion cellular isoform differs from the abnormal prion protein-scrapie-isoform in the secondary folding structure only
e- prominent autonomic and endocrine disorders are against the diagnosis
Q11: Creutzfeldt-Jacob disease (CJD) , which is the wrong statement?
a- dementia is present virtually in all cases
b- focal cortical signs like aphasia and apraxia may be seen early
c- psychiatric, behavioral and personality changes are common
d- aside from cognitive abnormalities, the most frequent clinical manifestation is myoclonus
e- progression to akinetic mutism or coma typically ensues over a period of many years
Q12: Creutzfeldt-Jacob disease (CJD) , which is the wrong statement?
a- the EEG may show periodic sharp waves or spike in 65% of cases
b- MRI of the brain may show hyper-intense lesions in the basal ganglia
c- the levels of protein 14-3-3 are markedly decreased in the CSF
d- in familial cases ,definitive diagnosis can be done by detection of the mutant form
of PrPc in DNA from peripheral blood lymphocyte
e- the CSF protein may be elevated
Q13: Creutzfeldt-Jacob disease (CJD), which is the wrong statement?
a- should be differentiated from Alzheimer's disease
b- might be confused with Parkinson's disease or progressive surpranuclear palsy c- intracerebral mass lesion may simulate it
d- it is invariably fatal disease
e- death usually occur with 10 year after the onset of symptoms
Q14: Normal pressure hydrocephalus, which is the wrong statement?
Trang 5a- a potentially reversible cause of dementia.
b- it might be idiopathic
c- the dementia is usually severe and rapidly progressive
d- aphasia and agnosias are rare
e- it is supposed to be due to impaired absorption of the CSF at the level of arachnoid granulation over the cerebral convexities
Q15: Normal pressure hydrocephalus, which is the wrong statement?
a- usually develops over a period of weeks to months
b- the initial abnormality is usually gait apraxia
c- urinary incontinence is a late development
d- pyramidal signs are very common
e- motor perseveration and grasp reflex in the hands and feet may occur
Q16: Normal pressure hydrocephalus, which is the wrong statement?
a- the CSF opening pressure is usually elevated
b- Brain CT scan usually shows dilated ventricles without cortical atrophy
c- radionuclide cisternography classically reveals isotop accumulation in the
ventricles
d- transient improvement following removal of 50 ml of CSF at lumbar puncture is the best predictor of a favorable clinical response to shunting
e- complications of shunting unfortunately occur in 1/3rd of cases
Q17: Dementia with Lewy bodies, which is the wrong statement?
a- it is the 2nd commonest cause of dementia
b- Lewy bodies are present in the cerebral cortex and brain stem
c- Lewy bodies contain alpha-synnuclein only
d- dementia with Lewy bodies is found in patient with and without histological features of Alzheimer's disease
e- In contrast to Alzheimer's disease, it is characterized by cognitive decline with a prominent early loss of recent memory
Q18: Characterisitic features of dementia with Lewy bodies, which is the wrong
statement?
a- fluctuating cognitive function
b- visual hallucinations
c- Parkinsonism
d- may respond to donepezil
e- high response rate to antipsychotics
Q19: Brain tumors-associated dementia, which is the wrong statement?
a- might be due to brain edema, compression of adjacent brain structures, raised intracranial pressure and impairment of cerebral blood flow
b- the tumor most likely producing this picture is of the pituitary gland
c- this type of dementia is characterized by mental slowness and apathy
d- there might be associated agnosias or aphasia
e- seizures might be seen
Q20: AIDS-dementia complex, which is the wrong statement?
Trang 6a- it is the commonest neurological complication of AIDS.
b- it might be the presenting feature of AIDS
c- it results from invasion of the brain with HIV-1 early in the course after acquisition
of the virus
d- HIV-1 replicates in neurons and glia of the brain with resulting neuronal death e- might be preceded by a history of symptomatic HIV-1 meningitis
Q21: AIDS-dementia complex, which is the wrong statement?
a- the onset is usually rapidly progressive with prominent agitation
b- examination may reveal cerebellar ataxia and extensor planters
c- fecal and urinary incontinence are late features
d- organic psychosis is common lately in the course
e- myoclonus and seizures can be prominent
Q22: AIDS-dementia complex, which is the wrong statement?
a- MRI may reveal diffuse cortical atrophy
b- in 20% of cases there is mild mononuclear pleocytosis in the CSF
c- CSF oligoclonal bands might be seen
d- HIV serology are positive
e- CSF protein is elevated in 10% of case only
Q23: General paresis of insane (GPI), which is the wrong statement?
a- it is a chronic meningo-encephalitis caused by active spirochetal infection of the brain
b- the onset is usually gradual with memory loss, altered affect or vague personality changes
c- incontinence ,seizures and stroke are very common early feature
d- there is trombone tremor of the face and tongue
e- pyramidal signs and paucity of facial features are common
Q24: Prognosis General Paresis of Insane (GPI) after receiving penicillin, which
is the wrong statement?
a- the clinical condition may improve
b- asymptomatic patients with persistent CSF abnormalities should be not be
retreated
c- patients with symptomatic progression should be retreated
d- patients with reactive CSF syphilis serology but without pleocytosis are unlikely to respond to penicillin
e- patients with reactive CSF syphilis serology but without pleocytosis should receive treatment
Q25: Progressive multi-focal encephalopathy, which is the wrong statement?
a- results from infection with a papovavirus
b- most healthy adults are sero-positive for this virus
c- the virus infects the cortical neurons
d- the course of the disease is subacute
e- the disease rarely symptomatic in those with intact immune functions
Q26: Progressive multi-focal encephalopathy, which is the wrong statement?
a- fever and systemic features are absent
Trang 7b- dementia is prominent.
c- hemiparesis, visual field defects and aphasia are very common and prominent d- ataxia and headache are uncommon
e- seizures are very commonly seen
Q27: Progressive multi-focal encephalopathy, which is the wrong statement?
a- the CSF is usually normal
b- MRI study usually shows diffuse white matter abnormalities
c- definitive diagnosis is usually done by brain biopsy
d- the disorder is fortunately rarely fatal
e- treatment with cytosine arabinocide is unsuccessful
Q28: Marchiafava Bignami syndrome, which is the wrong statement?
a- characterized by necrosis of the corpus callosum and subcortical white matter in malnourished alcoholics
b- the course could be acute, subacute or chronic
c- characterized by dementia, spasticity, gait disorders
d- no specific treatment is available
e- virtually all patients will die
Q29: Dialysis dementia, which is the wrong statement?
a- it is seen uremic patients on chronic long term hemodialysis
b- caused by gradual accumulation of aluminum in the body
c- the classical features are dementia, myoclonus, seizures and dysarthria
d- the EEG shows paroxysmal high voltage slowing with intermixed spikes and slow waves
e- the incidence is gradually increasing
Q30: Non-Wilsonian hepatocerebral degeneration, which is the wrong
statement?
a- it is an uncommon complication of hepatic cirrhosis
b- the syndrome is usually fluctuating but progressive over 1-9 years
c- dementia is characterized by mental slowness , apathy, impaired concentration and memory disturbance
d- pyramidal, extrapyramidal and cerebellar signs are common
e- CSF polymorphonuclear pleocytosis is very common
Q31: Chronic subdural hematoma-associated dementia, which is the wrong statement?
a- usually seen in old people following a minor head truma
b- the hematoma is bilateral in 1/6th of cases
c- the symptoms may be delayed for several weeks or months after development of hematoma
d- headache is usually the last symptom
e- the classical presentation is with cognitive disturbance, hemiparesis, papilleodema and extensor planters
Q32: Vascular dementia, which is the wrong statement ?
a- it is the 3rd commonest cause of dementia
Trang 8b-those patients either have multiple large cortical infarcts or multiple small deep lacunar infacrts
c- the relationship of the cerebrovascular disease and the development of dementia is poorly characterized
d- the majority of patients are normo-tensive
e- the onset may be more or less abrupt
Q33: Vascular dementia, which is the wrong statement?
a- pseudobulbar palsy is very common
b- there is focal sensori-motor deficits with ataxia and gait apraxia
c- MRI is less sensitive than CT scan at detecting the brain abnormalities
d- a search for vasculitis and meningovascular syphilis should be done in younger patients
e- antiplatelet agents are usually given
Q34: Pseudo-dementia, which is the wrong statement?
a- depression is the commonest disorder mistaken for dementia
b- depression can be a feature of dementia and both disorders often coexist
c- prominent vegetative symptoms are in favor of dementia
d- somatic complaints are uncommon in dementia
e- cognitive impairment that is more prominent at night is in favor of dementia
Subchapter: C
Q1: Head trauma associated amnesia, which is the wrong statement?
a-head traumas causing loss of consciousness always result in an amnestic syndrome b-features of transient global amnesia may be seen
c-retrograde amnesia may bee seen
d-anterograde amnesia is not seen
e-after the head injury, the patient may behave normally in an automatic fashion
Q2: Cerebral hypoxia and ischemia- associated amnesia, which is the wrong statement?
a-such an amnesia tends to occur in those who are in coma for more than 12 hours b-mainly attributed to damage in the pyramidal neurons of the hippocampus in the Sommer sector of the hippocampus
c-there is severe impairment in the formation of new memories with relative
preservation of registration
d-the patient may sometimes confabulate
e-characteristically ,retrograde amnesia is not seen
Q3: Cerebral hypoxia and ischemia- associated amnesia, which is the wrong statement?
a-it may be the sole manifestation following a cardiac arrest event
b-following a cardiac arrest, this syndrome may coexist with cerebral watershed syndromes
c-recovery from this amnestic syndrome often occurs within several days
d-carbon monoxide poisoning associated -amnestic syndromes are frequently
associated with prominent affective disturbances
e-in carbon monoxide poisoning associated -amnestic syndromes the brain CT scan usually shows hyperdense areas in the frontal cortex
Trang 9Q4: Bilateral cerebral artery occlusion-associated amnesia, which is the wrong statement?
a- bilateral cerebral artery occlusion associated-amnestic syndrome may be a transient
or a permanent one
b-usually caused by emboli to the internal carotid arterial system
c-the resulting amnestic syndrome may be associated with unilateral or bilateral hemianopia
d-signs of upper midbrain dysfunction may be prominent
e-recent memory tends to be affected with relative preservation of remote memory and registration
Q5: Transient global amnesia (TGA), which is the wrong statement?
a-it is an acute memory loss seen in middle aged people
b-most patients will have recurrent attacks
c-during the attack, knowledge of personal identity is characteristically preserved d-retrograde amnesia preceding the attack for a variable period may be seen
e-during the attack, new memories can not be formed
Q6: Transient global amnesia (TGA), which is the wrong statement?
a-during the spell, the patient appears to be perplexed and confused
b-unfortunately, the condition may be diagnosed as a psychogenic disturbance
c-all patients are completely healthy prior to the spells
d-CT scan may show abnormalities in the temporal lobes during the spells
e-diffusion-weighted MRI may show signal abnormalities during the spells
Q7: Alcoholic blackouts, which is the wrong statement?
a-caused by short term consumption of large amount of ethanol by chronic alcoholics b-defined as an acute amnestic syndrome that is not due to global confusion, seizures, head trauma, or Wernicke's encephalopathy
c-there is prominent inability to form new memories
d-may result from ethanol induced depression of synaptic neurotransmission
e-necessitates treatment with long term chlordiazepoxide tablets
Q8: Dissociative amnesia, which is the wrong statement?
a-characterized by an isolated or a disproportionate loss of traumatic or stressful personal memories
b-usually localized in time to the immediate aftermath of a traumatic experience c-in some cases ,the patients may be unable to remember their own name
d-recent memory is prominently affected
e-examination under hypnosis may helpful in establishing that the amnesia is
psychogenic in origin
Q9: Alcoholic Korsakoff's amnestic syndrome, which is the wrong statement?
a-usually preceded by one or more episodes of Wernicke's encephalopathy
b-the associated memory disorder is thought to be due to degeneration of the dorso-medial thalami
c-often associated with peripheral polyneuropathy
d-the classical defect is an impairment of recent memory and failure to form new ones
Trang 10e-the patient is characteristically agitated and has insight to his illness.
Q10: Post-encephalitic amnesia, which is the wrong statement?
a-following encephalitis, the patient may be left with a permanent and static and amnestic syndrome
b-confabulation are never seen
c-symptoms of limbic system disease may be prominent
d-complex partial seizures may be seen
e-the commonest cause of this syndrome is herpes simplex encephalitis
Q11: Brain tumor associated amnestic syndrome, which is the wrong statement?
a-it is a very common type of amnestic syndromes
b-tumors that produce this syndrome include those that are located within the 3rd ventricles
c-the amnestic syndrome resemble that of alcohol Koraskoff's one
d-deep midline tumors often produce prominent lethargy and headache
e-treatment depends on the underlying tumor type and location
Q12: Paraneoplastic limbic encephalaitis, which is the wrong statement?
a-it is an autoimmune inflammatory and degenerative disease that affects the gray matter of the limbic system
b-usually associated with small cell carcinoma of the lung
c-neuropathologically, there is neuronal loss, reactive gliosis, microglial proliferation, and perivascular lymphocytic cuffing
d-affective symptoms like depression or anxiety are rare late features
e-the manestic syndrome resembles that of alcohol Korsakoff's one
Q13: Paraneoplastic limbic encephalaitis, which is the wrong statement?
a-the CSF may show an elevated protein and mild mononuclear pleocytosis
b-EEG may show diffuse slowing or bitemporal slow wave and spikes
c-brain MRI may show signal abnormalities in the occipital lobes
d-up to 60% of patients have anti-neuronal antibodies in the serum and CSF
e-the paraneopastic syndrome can be static
Subchapter D:
Q1- Spontaneous subarachnoid hemorrhage (SAH), what is the wrong
statement?
a-usually caused by a ruptured Berry aneurysm or arterio-venous
malformation(AVM)
b-its annual incidence is 6 per 100 000 populations/ year
c-ruptured Berry's aneurysm is mostly seen during the 5th and 6th decades of life d-hypertension has not been conclusively demonstrated to predispose to the
formation of the aneurysm
e-AVMs are very common cause of it world wide
Q2: Spontaneous subarachnoid hemorrhage (SAH), what is the wrong
statement?
a-Berry's aneurysm although is said to be congenital, it results from developmental weakness in the arterial wall
b-Berry's aneurysm is multiple in 90% of cases