121- A 72-year-old lady has 4 months of memory loss, urinary incontinence and falls. On examination she has mild memory loss and a broad-based, slow gait. Muscle tone is normal and both plantar reflexes are downgoing. What is the likely diagnosis?
1) Alzheimer's disease
2) Frontal lobe dementia
3) Mulit-infarct dementia
4) Normal-pressure hydrocephalus
5) Parkinson's disease
Answers-4
122- Baclofen
1) acts directly on skeletal muscle
2) causes rhabdomyolysis
3) reduces cerebral but not spinal spasticity
4) cause hallucinations when withdrawn
5) reduce Ca2+ release from sarcoplasmic reticulum
Answers-4
123- A 26-year-old previously healthy woman has the sudden onset of mental confusion. She has a seizure and is brought to the hospital. Her vital signs show blood pressure 100/60 mm Hg, temperature 37 C., pulse 89, and respirations 22. A lumbar puncture reveals a normal opening pressure, and clear, colorless cerebrospinal fluid is obtained with 1 RBC and 20 WBC's (all lymphocytes), with normal glucose and protein. An MRI scan reveals swelling of the right temporal lobe with hemorrhagic areas. Which of the following infectious agents is the most likely cause for these findings?
1) Haemophilus influenzae
2) Herpes simplex virus
3) Influenza virus
4) Mycobacterium tuberculosis
5) Neisseria meningitidis
Answers-2
124- Which of the following statements regarding central pontine myelinolysis is correct?
1) Consciousness is preserved characteristically.
2) MR imaging shows diagnostic features in the majority of patients.
3) The cause has been linked to over-rapid correction of hyponatraemic states.
4) The condition is confined to malnourished alcoholic patients.
5) The pathological changes are confined to the pons.
Answers-3
125- A 48 year old man presented with a two week history of recurrent severe right-sided peri-orbital headache, frequently nocturnal and occurring at least once daily, usually lasting an hour. He had noticed lacrimation from the right eye and blockage of the right nostril during the headache. At the time of the examination he was free from headache and there were no abnormal physical signs.
Which of the following is the most likely diagnosis?
1) cluster headache
2) intracranial aneurysm
3) orbital pseudotumour
4) right maxillary sinusitis
5) trigeminal neuralgia
Answers-1
126- Which of the following is a true of myasthenia gravis?
1) there is a strong association with anti-noradrenergic receptor antibodies
2) neurotransmitter released at the motor end plate is greatly reduced
3) repetitive stimulation of a motor nerve produces a reduction in the amplitude of the 5th response compared with the 1st in 98% of cases (electrodecremental test)
4) electrical recordings of single motor unit activity commonly reveal variation in the latency of the various mucle fibre responses (jitter)
5) subjective improvement in muscle strength following edrophonium is diagnostic of the condition
Answers-4
127- A 55-year-old man has progressive weakness of his hands over a period of 1 year. Examination reveals wasting of the muscles of the hands and forearms and fasciculation. There is hyper-reflexia of his lower limbs and upgoing plantars. Sensation is normal. Which of the following is the most likely diagnosis?
1) Alzheimer's disease
2) Motor Neurone Disease
3) Multiple Cerebral Infarcts
4) Multiple Sclerosis
5) Syringolmyelia
Answers-2
128- A 25-year-old female presented with 6 months history of depression, irritability and painful sensory symptoms in her legs. Over the last 4 weeks she presents a broad base ataxic gait. An MRI brain showed bilateral posterior thalamic nuclei (pulvinar region) high signals.
The most likely diagnosis is:
1) Sporadic CJD
2) New variant CJD
3) Wilson disease
4) Multiple system atrophy
5) Herpes simplex encephalitis
Answers-2
129- A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
1) Alzheimer type dementia
2) chronic sub-dural haematoma
3) Creutzfeldt-Jacob disease
4) depressive stupor
5) normal pressure hydrocephalus
Answers-2
130 -A lesion of the Frontal lobe causes:
1) Apraxia
2) Broca's (expressive) aphasia
3) Cortical blindness
4) Homonymous hemianopia
5) Visuospatial neglect
Answers-2
131- A 65-year-old man has a monotonous, slurred speech. He has an expressionless face and a festinant gait. There is also impairment of vertical gaze. What is the most likely underlying aetiology?
1) Shy-Drager syndrome
2) idiopathic
3) cerebrovascular disease
4) Wilson's disease
5) Steele-Richardson-Olszewski syndrome
Answers-5
132- Which of the following may cause a downbeat nystagmus?
1) Chiari type I malformation
2) Unilateral medial longitudinal fasciculus lesion
3) Central cerebellar lesion
4) Wernicke's encephalopathy
5) Aqueduct stenosis
Answers-1
133- A 35 year old female presents with headaches. Examination reveals papilloedema. Which of the following would make the diagnosis of benign intracranial hypertension unlikely?
1) Absence of retinal venous pulsations
2) Bilateral upgoing plantar responses
3) Normal ventricles on CT or MRI scan
4) Reduced visual acuity
5) VIth cranial nerve palsy
Answers-2
134-A teenage girl presents with Guillain-Barre syndrome. Her weakness continues to worsen after admission to hospital. Which of the following
should be used to monitor her?
1) arterial blood gases
2) chest expansion size
3) FEV1/FVC ratio
4) PEFR
5) vital capacity
Answers-5
135- A 60 year old man has Parkinson's disease. He is started on treatment with L-dopa and dopa decarboxylase inhibitor therapy. However he continues to have troublesome tremor. Which of the following drugs would be most likely to help?
1) Amantadine.
2) Benzexol.
3) Propranolol
4) Ropinirole
5) Selegiline
Answers-2
1) Alzheimer's disease
2) Frontal lobe dementia
3) Mulit-infarct dementia
4) Normal-pressure hydrocephalus
5) Parkinson's disease
Answers-4
122- Baclofen
1) acts directly on skeletal muscle
2) causes rhabdomyolysis
3) reduces cerebral but not spinal spasticity
4) cause hallucinations when withdrawn
5) reduce Ca2+ release from sarcoplasmic reticulum
Answers-4
123- A 26-year-old previously healthy woman has the sudden onset of mental confusion. She has a seizure and is brought to the hospital. Her vital signs show blood pressure 100/60 mm Hg, temperature 37 C., pulse 89, and respirations 22. A lumbar puncture reveals a normal opening pressure, and clear, colorless cerebrospinal fluid is obtained with 1 RBC and 20 WBC's (all lymphocytes), with normal glucose and protein. An MRI scan reveals swelling of the right temporal lobe with hemorrhagic areas. Which of the following infectious agents is the most likely cause for these findings?
1) Haemophilus influenzae
2) Herpes simplex virus
3) Influenza virus
4) Mycobacterium tuberculosis
5) Neisseria meningitidis
Answers-2
124- Which of the following statements regarding central pontine myelinolysis is correct?
1) Consciousness is preserved characteristically.
2) MR imaging shows diagnostic features in the majority of patients.
3) The cause has been linked to over-rapid correction of hyponatraemic states.
4) The condition is confined to malnourished alcoholic patients.
5) The pathological changes are confined to the pons.
Answers-3
125- A 48 year old man presented with a two week history of recurrent severe right-sided peri-orbital headache, frequently nocturnal and occurring at least once daily, usually lasting an hour. He had noticed lacrimation from the right eye and blockage of the right nostril during the headache. At the time of the examination he was free from headache and there were no abnormal physical signs.
Which of the following is the most likely diagnosis?
1) cluster headache
2) intracranial aneurysm
3) orbital pseudotumour
4) right maxillary sinusitis
5) trigeminal neuralgia
Answers-1
126- Which of the following is a true of myasthenia gravis?
1) there is a strong association with anti-noradrenergic receptor antibodies
2) neurotransmitter released at the motor end plate is greatly reduced
3) repetitive stimulation of a motor nerve produces a reduction in the amplitude of the 5th response compared with the 1st in 98% of cases (electrodecremental test)
4) electrical recordings of single motor unit activity commonly reveal variation in the latency of the various mucle fibre responses (jitter)
5) subjective improvement in muscle strength following edrophonium is diagnostic of the condition
Answers-4
127- A 55-year-old man has progressive weakness of his hands over a period of 1 year. Examination reveals wasting of the muscles of the hands and forearms and fasciculation. There is hyper-reflexia of his lower limbs and upgoing plantars. Sensation is normal. Which of the following is the most likely diagnosis?
1) Alzheimer's disease
2) Motor Neurone Disease
3) Multiple Cerebral Infarcts
4) Multiple Sclerosis
5) Syringolmyelia
Answers-2
128- A 25-year-old female presented with 6 months history of depression, irritability and painful sensory symptoms in her legs. Over the last 4 weeks she presents a broad base ataxic gait. An MRI brain showed bilateral posterior thalamic nuclei (pulvinar region) high signals.
The most likely diagnosis is:
1) Sporadic CJD
2) New variant CJD
3) Wilson disease
4) Multiple system atrophy
5) Herpes simplex encephalitis
Answers-2
129- A 70-year-old woman presented with episodic impairment of consciousness.
Which of the following is the most likely cause?
1) Alzheimer type dementia
2) chronic sub-dural haematoma
3) Creutzfeldt-Jacob disease
4) depressive stupor
5) normal pressure hydrocephalus
Answers-2
130 -A lesion of the Frontal lobe causes:
1) Apraxia
2) Broca's (expressive) aphasia
3) Cortical blindness
4) Homonymous hemianopia
5) Visuospatial neglect
Answers-2
131- A 65-year-old man has a monotonous, slurred speech. He has an expressionless face and a festinant gait. There is also impairment of vertical gaze. What is the most likely underlying aetiology?
1) Shy-Drager syndrome
2) idiopathic
3) cerebrovascular disease
4) Wilson's disease
5) Steele-Richardson-Olszewski syndrome
Answers-5
132- Which of the following may cause a downbeat nystagmus?
1) Chiari type I malformation
2) Unilateral medial longitudinal fasciculus lesion
3) Central cerebellar lesion
4) Wernicke's encephalopathy
5) Aqueduct stenosis
Answers-1
133- A 35 year old female presents with headaches. Examination reveals papilloedema. Which of the following would make the diagnosis of benign intracranial hypertension unlikely?
1) Absence of retinal venous pulsations
2) Bilateral upgoing plantar responses
3) Normal ventricles on CT or MRI scan
4) Reduced visual acuity
5) VIth cranial nerve palsy
Answers-2
134-A teenage girl presents with Guillain-Barre syndrome. Her weakness continues to worsen after admission to hospital. Which of the following
should be used to monitor her?
1) arterial blood gases
2) chest expansion size
3) FEV1/FVC ratio
4) PEFR
5) vital capacity
Answers-5
135- A 60 year old man has Parkinson's disease. He is started on treatment with L-dopa and dopa decarboxylase inhibitor therapy. However he continues to have troublesome tremor. Which of the following drugs would be most likely to help?
1) Amantadine.
2) Benzexol.
3) Propranolol
4) Ropinirole
5) Selegiline
Answers-2
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