MCQ Neurology

Neurology MCQs 1 With regards to SAH, all are true, EXCEPT: A

Polycystic kidney disease is a risk factor

B

Widened QRS can be an ECG finding

C

Sensitivity of CT at one week is 75%

D

Xanthochromia in CSF lasts for 2 weeks after event

Answer 2 With regards to cerebral lobe functions all are TRUE, EXCEPT: A

Gerstmann’s syndrome is a dominant parietal lobe sign

B

Dressing apraxia is a nondominant parietal lobe sign

C

Receptive dysphasia is a dominant temporal lobe sign

D

Sensory and visual neglect are temporal lobe signs

Answer 3 Which of the following is TRUE regarding headaches? A

50% of brain tumours don’t cause headaches

B

Ergotamine is useful in migraine therapy in pregnant women

C

Sumatriptan for migraine headaches can only be given orally

D

Migraine without aura (common migraine) can last up to one week

Answer 4 Causes of Benign Intracranial Hypertension include all the following EXCEPT A

The Oral Contraceptive Pill

B

Addisons’ disease

C

Vitamin A

D

Chloramphenicol

Answer

5 Regarding thrombolysis in acute ischaemic CVA – the following statements are true EXCEPT A

Important exclusion criteria includes evidence of intra-cranial haemorrhage on CT, acute infarct involving > 1/3 of MCA territory

B

‘tPA’ is the only thrombolytic agent registered for this purpose

C

Current evidence supports use of ‘tPA’ within 3 hours of onset of symptoms in selected patients

D

Hypertension precluding use of ‘tPA’ is defined as BP > 160/100 mmHg

Answer 6 A patient presents to the ED with diplopia. Which of the following is rd INCONSISTENT with a diagnosis of right 3 nerve palsy? A

Inability to fully adduct the right eye

B

Dilated right pupil

C

Inability to fully abduct the right eye

D

Right ptosis

Answer 7 Which of the following is MOST commonly the cause of epidural abscess A

Lumbar puncture

B

Local spread from osteomyelitis

C

Penetrating trauma

D

Haematogenous spread from distant source

Answer

8 The Brown-Sequard syndrome refers to a hemicord syndrome consisting of A

Ipsilateral loss of pain and vibration sense with contralateral motor paralysis and loss of proprioception and temperature sense

B

Ipsilateral motor paralysis, loss of pain and temperature sense with contralateral loss of proprioception and vibration sense

C

Ipsilateral motor paralysis, loss of proprioception and loss of vibration sense with contralateral loss of pain and temperature sense

D

Ipsilateral motor paralysis with contralateral loss of pain, proprioception, vibration and temperature sense

Answer 9 Which of the following myotomes is MOST responsible for wrist extension? A

C5 + C6

B

C6 + C7

C

C7 + C8

D

C8 + T1

Answer

10

Which spinal levels are MOST responsible for the brachioradialis (supinator) muscle stretch reflex.?

A

C5 + C6

B

C6 + C7

C

C7 + C8

D

C8 + T1

Answer

11

Which statement is FALSE regarding TIA?

A

95% of TIA’s caused by athero thrombo-embolism, cardiogenic embolism, small vessel disease

B

Management of TIA’s aimed at decreasing risk for subsequent CVA which is a major cause of death or long-term disability

C

Anti-platelet therapy remains the cornerstone of therapy

D

Aspirin may be commenced without head CT if TIA > 72 hrs ago

Answer

12

Which statement is TRUE regarding TIA?

A

There are well established management guidelines in the literature for management of patients suffering TIA

B

Commencing Aspirin therapy depends on patient disposition

C

Warfarin therapy needs to be commenced after therapeutic heparinisation.

D

There is no role for lowering Blood Pressure in ED unless evidence of hypertensive emergency.

Answer

13

A 40 yo male walks into the ED with recent onset of fever and malaise. He complains of headache, myalgia and sore throat. He also complains of recent micturition difficulty. He is known to have MS but has not had an exacerbation for “long time”. His vital signs are BP 100/50, HR 122, T 38.7, RR 24 and Pulse oximetry at 96% on room air. All of the following are true except:

A

Antibiotics are likely to be a feature in his management

B

Suxamethonium is not contraindicated in the event of needing intubation

C

A seizure in the dept. warrants a CT brain

D

The presence of erythema in his throat confirms he has Viral pharyngitis

Answer

14

Regarding tetanus

A

Symptom resolution occurs over weeks to months

B

Wound culture of C. tetani is essential for confirming diagnosis

C

Neurotransmitter release in inhibitory nerves is blocked by C tetani bacteria that migrate into the CNS

D

Immunisation is scheduled for children at 2, 4, 6, 12 months then starting primary school and finishing high school

E

Early onset of symptoms is associated with increased mortality

Answer

15

All of the following are associated with increased risk for subarachnoid haemorrhage EXCEPT

A

Haemochromatosis

B

Polycystic kidney disease

C

Alpha-1-antitrypsin deficiency

D

Neurofibromatosis

E

Sickle cell disease

Answer

16

Which statement is FALSE regarding sensory dermatomes?

A

S1 also covers the lateral dorsum of the foot

B

L3 and S3 dermatomes are adjacent to each other in the lower back

C

The demonstration of a preserved peroneal dermatome may be the only sign of an incomplete spinal cord injury

D

The posterior sensory fibres from C1 supply the skin to the occiput

Answer

17

Regarding the Mini Mental State Examination (MMSE), which is TRUE?

A

Can be substituted by the Quick Confusion Scale to assess the emotional and intellectual functioning of the individual

B

A score less than 20 indicates the presence of dementia or another cognitive disorder

C

Contains six elements including Appearance, Disorders of thought, Disorders of perception, Mood and affect, Insight and judgement, and Sensorium and intelligence

D

The score must be above 23 to be considered within ‘normal’ limits

Answer

18

In a cranial nerve defect you would expect to find…

A

Impairment of downward gaze with a trochlear lesion.

B

Weakness of trapezius and genioglossus from an accessory nerve injury.

C

Bradycardia and hypertension directly from a medullary lesion of CN X.

D

A lateral rectus palsy from injury to CN VI inside the cavernous sinus.

Answer

19

Which of the following is TRUE of infective neurological conditions?

A

In an infant with FTT, poor feeding, constipation and impaired respiration a history of honey ingestion would encourage the use of metronidazole treatment.

B

75y.o.

B

Fever

C

Presence for more than 4 days

D

Rapidity of onset

Answer

37

Features of the lateral medullary syndrome include all the following EXCEPT:

A

Ipsilateral upper motor neurone signs involving CN VII, IX, X

B

Ipsilateral Horner’s syndrome

C

Contralateral hemiplegia

D

Contralateral spinothalamic loss (pain, temperature)

Answer

38

Non-epileptic events of infancy include the following EXCEPT:

A

Infantile spasms

B

Self-stimulatory episodes

C

Shuddering attacks

D

Stereotypies

Answer

39

Which of the following statements about dystonic reactions are FALSE?

A

It is not a life-threatening reaction

B

There are four characteristic types – oculogyric, buccolingual, torticollis & tortipelvis

C

Benzodiazepines are a second-line treatment

D

Thought to be due to both dopaminergic and serotonergic blocking drug effects

Answer

40

Which of the following diseases does NOT cause altered sensation?

A

Botulism

B

Tetanus

C

Motor neurone disease

D

Eaton Lambert syndrome

E

Bell’s palsy

Answer

41

Regarding the treatment of acute ischaemic stroke, which is FALSE?

A

Aspirin and Clopidogrel should be given either immediately before or immediately after thrombolysis with tPA if thrombolysis is indicated

B

IV Heparin is not useful as first-line therapy

C

Clopidogrel has not been shown to be beneficial

D

Focal mass effect with hemispheric swelling on CT scan is a contraindication to thrombolysis

Answer

42

Regarding cavernous sinus thrombosis, which is TRUE?

A

Is typically associated with the ‘delta sign’ on CT scan

B

Is suggested by palsies of the cranial nerves III, IV and VI

C

Is less common post-partum than sagittal sinus thrombosis

D

MRI has no role in its diagnosis

Answer

43

In regards to meningitis in children, which of the following is TRUE?

A

In infants the most common cause is N. meningitidis

B

In children under 15, N meningitidis group B is the most common cause

C

The CSF is always abnormal in meningitis

D

CSF protein is normally decreased

Answer

44

With Cerebral Lobe Dysfunction, which is TRUE?

A

Gerstmann's Syndrome comprises parietal dominant signs of, dressing apraxia, acalculia and agraphia

B

Astereognosis represents a dominant parietal lobe sign

C

Receptive dysphasia occurs with a lesion in the dominant lobe posterior third of the frontal gyrus

D

Nominal dysphasia occurs with a lesion in angular gyrus of the median temporal lobe

Answer

45

Which is TRUE regarding Guillain-Barre syndrome?

A

EBV and CMV are thought to be the two major precipitants

B

There are more cases in winter than summer

C

The facial nerve is commonly involved

D

Presentation is with a pure motor disturbance

Answer

46

Which is TRUE regarding Neisseria meningitidis meningitis?

A

It is a Gram –ve bacillus

B

It is the commonest cause of meningitis in adults + children

C

There are 3 known serogroups

D

Humans are the only natural reservoir

Answer

47

Which of the following statements is TRUE with regards encephalitis?

A

CMV can be treated with Aciclovir

B

EEG can be diagnostic for VZV infection

C

Unlike meningitis, infects both meninges and subarachnoid space

D

Rabies virus travels within and via peripheral neurones to reach the brain

Answer

48

In hypersensitivity reactions

A

Type 2 are immune complex mediated

B

Post strep GN is an example of Type 2 reaction

C

Anaphylactoid reactions are IgE mediated

D

Mantoux test relies on Type 4 reactions

Answer

49

In regards to the NINDS trial, which is TRUE

A

The NINDS study had a representative sample of patients

B

The NINDS trial resulted in a significantly decreased mortality in the treatment group

C

A modified Rankin score of 2 “Slight disability but able to carry out usual activities’ was not considered a favourable outcome

D

It is not resource intensive and should be reproducible by most EDs

Answer

50

With regard to cavernous sinus thrombosis which is CORRECT:

A

Strep Pneumoniae is the causative organism in the majority of cases.

B

Anticoagulation has no role to play in treatment

C

Lumbar puncture will reveal CSF with elevated protein and WBC in most patients

D

Contrast CT may show filling defect only

Answer

51

With regard to optic neuritis, which of the following is INCORRECT:

A

Typically heralded by a dull retro-orbital ache, followed by monocular blurred vision over the next day.

B

Associated with painless eye movements

C

Central visual field defect is typical but there may be varying degrees of compromised visual acuity.

D

An afferent papillary defect may be present.

Answer

52

What finding in a patient with facial muscle weakness suggests a diagnosis other than Bell’s palsy?

A

Sparing of the frontalis muscle

B

History of preceding respiratory infection

C

Unilateral involvement

D

Altered taste sensation

Answer

53

With respect to Bacterial meningitis

A

Antibiotics should not be delayed for more than 90 minutes after initial assessment in suspected cases

B

Amoxicillin and Gentamicin are recommended alternative antibiotics

C

In the case of suspected Strep pneumoniae antibiotic resistance, Vancomycin is recommended

D

Moxifloxacin is recommended as first line treatment

Answer

Answers 1. C 2. D 3. A 4. D 5. D 6. C 7. D 8. C 9. C 10. A 11. D 12. D 13. D 14. 15. 16. D 17. D 18. D 19. A (80% HSV encephalitis have abnormal EEG, 90% HIV/AIDS get CNS infections, Steroids work in children with HiB/pneumo meningitis when given 30mins BEFORE AB’s, honey can cause Botulism in infants) 20. D 21. D 22. D 23. D 24. D Cameron 354, 7.2, stroke 25. C Cameron stroke chapter 26. D DUNN, LP,458 Neurology 27. D 28. B Dunn, p 437 29. C Cameron paeds, p 243 30. D

Dunn

31. D

Dunn

32. B

Cameron (Paed)

33. B

Cameron

34. D

(Cameron says 20% of pts rebleed within first 2 weeks!)

35. D

ACEM college guidelines

36. C

EMP

Shagreen in Tuberous Sclerosis and at lower back p236

Commonest in children 4-9 y.o

37. C

Dunn page 527

38. A

Cameron (Paeds)Neurology, page 231

39. D

Dunn

40. B

Dunn

41. A

Stroke update 2007: Better Early Stroke Treatment (BEST). Emergency Medicine

Practice August 2007; 9(8). th

42. B

Dunn 4 Ed. Chapter 16: Neurology. 553 – 554.

43. B

Cameron Paeds

44. D

Dunn 4 Ed pages 510-511

45. C

Dunn 4 ed p 563

46. D

Dunn 4 ed p 540

47. D

A-Ganciclovir is used for CMV, B-EEG is pathognomonic for HSV, C-encephalitis is

th th

rd

parenchymal infection, D-are you scratching yet, E- true…..Tintinalli. 48. D

Type 1 IgE mediated triggering mast cells (anaphylaxis NOT anaphylactoid). Type 2-cytotoxic where Antibody or compliment factors directly destroy cells (ABO, Rhesus) Type 3 - immune complex, where antigen antibody complex are deposited and then attract macrophages (post strep GN, serum sickness) Type 4 cell mediated (T cells) graft rejection, protozoal infection,

Mantoux. C1

esterase deficiency is not a hypersensitivity reaction, excess

bradykinin synthesis

causes oedema. Dunn 49. C

A False-study designed incorporated an over representation of patients at less than 90 minutes B False, no statistically significant mortality difference at True-Rankin score of 0=no symptoms, 1=able to carry out all reported scores of 0 and 1 as favourable D False-strict existed to optimize outcome E False-CT was

3 months C

activities. The study

management protocols

reviewed by consultant radiologist

50. C

EB Medicine – An evidence based approach to Abnormal vision pp 15, 16.

51. B

EB Medicine- An evidence Based approach to Abnormal Vision pp 13, 14.

52. A 53. C