Neurology MCQs 1 With regards to SAH, all are true, EXCEPT: A B C D Answer 2 With regards to cerebral lobe functions

all are TRUE, EXCEPT: A B C D Answer 3 Which of the following is TRUE regarding headaches? A B C D Answer 4 Causes of Benign Intracranial Hypertension include all the following EXCEPT A B C D Answer The Oral Contraceptive Pill Addisons disease Vitamin A Chloramphenicol 50% of brain tumours dont cause headaches Ergotamine is useful in migraine therapy in pregnant women Sumatriptan for migraine headaches can only be given orally Migraine without aura (common migraine) can last up to one week Gerstmanns syndrome is a dominant parietal lobe sign Dressing apraxia is a nondominant parietal lobe sign Receptive dysphasia is a dominant temporal lobe sign Sensory and visual neglect are temporal lobe signs Polycystic kidney disease is a risk factor Widened QRS can be an ECG finding Sensitivity of CT at one week is 75% Xanthochromia in CSF lasts for 2 weeks after event

5 Regarding thrombolysis in acute ischaemic CVA the following statements are true EXCEPT A B C D 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 B C D Answer 7 Which of the following is MOST commonly the cause of epidural abscess A B C D Answer Lumbar puncture Local spread from osteomyelitis Penetrating trauma Haematogenous spread from distant source Inability to fully adduct the right eye Dilated right pupil Inability to fully abduct the right eye Right ptosis Important exclusion criteria includes evidence of intra-cranial haemorrhage on CT, acute infarct involving > 1/3 of MCA territory tPA is the only thrombolytic agent registered for this purpose Current evidence supports use of tPA within 3 hours of onset of symptoms in selected patients Hypertension precluding use of tPA is defined as BP > 160/100 mmHg

8 The Brown-Sequard syndrome refers to a hemicord syndrome consisting of A B C D Answer 9 Which of the following myotomes is MOST responsible for wrist extension? A B C D Answer C5 + C6 C6 + C7 C7 + C8 C8 + T1 Ipsilateral loss of pain and vibration sense with contralateral motor paralysis and loss of proprioception and temperature sense Ipsilateral motor paralysis, loss of pain and temperature sense with contralateral loss of proprioception and vibration sense Ipsilateral motor paralysis, loss of proprioception and loss of vibration sense with contralateral loss of pain and temperature sense Ipsilateral motor paralysis with contralateral loss of pain, proprioception, vibration and temperature sense

10 A B C D Answer

Which spinal levels are MOST responsible for the brachioradialis (supinator) muscle stretch reflex.? C5 + C6 C6 + C7 C7 + C8 C8 + T1

11 A B C D Answer

Which statement is FALSE regarding TIA? 95% of TIAs caused by athero thrombo-embolism, cardiogenic embolism, small vessel disease Management of TIAs aimed at decreasing risk for subsequent CVA which is a major cause of death or long-term disability Anti-platelet therapy remains the cornerstone of therapy Aspirin may be commenced without head CT if TIA > 72 hrs ago

12 A B C D Answer

Which statement is TRUE regarding TIA? There are well established management guidelines in the literature for management of patients suffering TIA Commencing Aspirin therapy depends on patient disposition Warfarin therapy needs to be commenced after therapeutic heparinisation. There is no role for lowering Blood Pressure in ED unless evidence of hypertensive emergency.

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: Antibiotics are likely to be a feature in his management Suxamethonium is not contraindicated in the event of needing intubation A seizure in the dept. warrants a CT brain The presence of erythema in his throat confirms he has Viral pharyngitis

A B C D Answer

14 A B C D E Answer

Regarding tetanus Symptom resolution occurs over weeks to months Wound culture of C. tetani is essential for confirming diagnosis Neurotransmitter release in inhibitory nerves is blocked by C tetani bacteria that migrate into the CNS Immunisation is scheduled for children at 2, 4, 6, 12 months then starting primary school and finishing high school Early onset of symptoms is associated with increased mortality

15 A B C D E Answer

All of the following are associated with increased risk for subarachnoid haemorrhage EXCEPT Haemochromatosis Polycystic kidney disease Alpha-1-antitrypsin deficiency Neurofibromatosis Sickle cell disease

16 A B C D Answer

Which statement is FALSE regarding sensory dermatomes? S1 also covers the lateral dorsum of the foot L3 and S3 dermatomes are adjacent to each other in the lower back The demonstration of a preserved peroneal dermatome may be the only sign of an incomplete spinal cord injury The posterior sensory fibres from C1 supply the skin to the occiput

17 A B C

Regarding the Mini Mental State Examination (MMSE), which is TRUE? Can be substituted by the Quick Confusion Scale to assess the emotional and intellectual functioning of the individual A score less than 20 indicates the presence of dementia or another cognitive disorder Contains six elements including Appearance, Disorders of thought, Disorders of perception, Mood and affect, Insight and judgement, and Sensorium and intelligence The score must be above 23 to be considered within normal limits

D Answer

18 A B C D Answer

In a cranial nerve defect you would expect to find! Impairment of downward gaze with a trochlear lesion. Weakness of trapezius and genioglossus from an accessory nerve injury. Bradycardia and hypertension directly from a medullary lesion of CN X. A lateral rectus palsy from injury to CN VI inside the cavernous sinus.

19 A

Which of the following is TRUE of infective neurological conditions? In an infant with FTT, poor feeding, constipation and impaired respiration a history of honey ingestion would encourage the use of metronidazole treatment. <80% of HIV/AIDS patients contract CNS infections. When giving steroids for meningitis they should be given after antibiotics for best effect. There is no role for EEG in infective encephalitis.

B C D Answer

20 A B C D Answer

Which of the following is TRUE in regard to Transverse Myelitis? Typically presents with an insidious gradual onset. Most cases will fully resolve over three-six months Dorsal column mediated sensory loss is much less common than lateral spinothalamic tract mediated loss. Can be caused by Epstein Barr virus infection.

21 A B C D Answer

Which of the following is NOT a typical associated neurological presentation of HIV infection? Painful sensory neuropathy Guillain Barre syndrome Dementia Labyrinthitis

22 A B C D Answer

Which of the following is NOT a recognised cause of acute ataxia in children? Eucalyptus oil Carbamazepine Measles Salmonellosis

23 A B C D Answer

All of the following are risk factors for Subarachnoid haemorrhage EXCEPT Fibromuscular dysplasia Marfans syndrome Smoking Hormone replacement therapy

24 A B C D Answer

Which of the following is NOT representative of a dominant cerebral hemisphere stroke? Dysphasia Acalculia Agraphia Unilateral spatial neglect

25 A B C D Answer

Regarding stroke, which is TRUE? 96% of right handed people have a right sided dominant hemisphere Stroke of the dominant hemisphere will produce dyspraxia Ipsilateral cranial nerve/ cerebellar signs and contra-lateral long tract signs are indicative of a brainstem stroke Lateral medullary syndrome is due to a stroke of the posterior cerebral artery

26 A B C D Answer

Regarding lumbar punctures, which is TRUE? In viral meningitis the CSF glucose is always normal CSF pressure can be reliably measured in a sitting position Diabetic coma produces an elevation in CSF pressure A low body mass index increases your chance of a post LP headache

27 A B C D Answer

Which of the following is FALSE in regard to Epilepsy? Petit mal seizures are a type of generalised epilepsy Non convulsive status should be considered if a patient has not recovered consciousness after treatment of a seizure The treatment of Isoniazid induced seizures is Pyridoxine Absence seizures are a type of partial epilepsy

28 A B C D Answer

Clinical clues that support a bacterial rather than viral aetiology in adult meningitis include all of the following EXCEPT Onset < 24 hours Headache Fever Confusion

29 A B C D Answer

Regarding acute ataxia in children which of the following is FALSE? Cerebellar ataxia is the most common Drug toxicity is a common cause Cerebellar lesions have an insidious onset Posterior fossa tumours are a common cause

30 A B C D Answer

In regard to neuropathies, which of the following is TRUE Botulism is caused by Ach-Receptor antibodies Myasthenia Gravis is an autoimmune disease with blockage of Ach-release Myasthenia Gravis is assoc in rare cases with thymic hyperplasia Suxamethonium should be avoided in Guillain Barre

31 A B C D Answer

In regard to neurofibromatosis which of the following is FALSE Tetanus is more common in IVDU Type II Neurofibromatosis is characterised by vestibular schwannomas Plexiform Neurofibromas are major cause of death Shagreen patches are yellow skin patches around the umbilicus

32 A B C D Answer

Which of the following is FALSE in regard to Guillain-Barre syndrome in children? Cranial nerves are involved in 50% of cases More common in late childhood (12-17 years) The commonest presenting symptoms are weakness and falls. Tick paralysis is an important differential diagnosis

33 A B C D Answer

Regarding strokes, which of the following statements is CORRECT? Approximately 5% of ischaemic CVAs are due to emboli originating from the heart. Posterior cerebral artery occlusion is manifested by visual changes of homonymous hemianopia, typically with macular sparing. Approximately 35% of strokes are haemorrhagic. Atherosclerosis of the internal carotid artery usually affects the distal 2cm of the artery.

34 A B C D Answer

With regards to SAH, which of the following statements is INCORRECT? Up to 50% of patients experience a sentinel haemorrhage in the hours to days before the major bleed. Nausea and vomiting are present in 75% of patients. Signs of meningism, including fever, photophobia and neck stiffness, are present in 75% of patients. 5% of patients rebleed within the first 2 weeks after the initial haemorrhage.

35 A B C

When writing Neurology MCQs which of the following is FALSE? They are a chance for the examiner to flaunt obscure knowledge They should set out confuse and baffle the candidate They should examine minutiae a neurology professor would be proud to know

They should examine a candidates knowledge of important or frequently seen neurological conditions

Answer

36 A B C D Answer

With regards to headache which are NOT red flags? Age>75y.o. Fever Presence for more than 4 days Rapidity of onset

37 A B C D Answer

Features of the lateral medullary syndrome include all the following EXCEPT: Ipsilateral upper motor neurone signs involving CN VII, IX, X Ipsilateral Horners syndrome Contralateral hemiplegia Contralateral spinothalamic loss (pain, temperature)

38 A B C D Answer

Non-epileptic events of infancy include the following EXCEPT: Infantile spasms Self-stimulatory episodes Shuddering attacks Stereotypies

39 A B C D Answer

Which of the following statements about dystonic reactions are FALSE? It is not a life-threatening reaction There are four characteristic types oculogyric, buccolingual, torticollis & tortipelvis Benzodiazepines are a second-line treatment Thought to be due to both dopaminergic and serotonergic blocking drug effects

40 A B C D E Answer

Which of the following diseases does NOT cause altered sensation? Botulism Tetanus Motor neurone disease Eaton Lambert syndrome Bells palsy

41 A B C D Answer

Regarding the treatment of acute ischaemic stroke, which is FALSE? Aspirin and Clopidogrel should be given either immediately before or immediately after thrombolysis with tPA if thrombolysis is indicated IV Heparin is not useful as first-line therapy Clopidogrel has not been shown to be beneficial Focal mass effect with hemispheric swelling on CT scan is a contraindication to thrombolysis

42 A B C D Answer

Regarding cavernous sinus thrombosis, which is TRUE? Is typically associated with the delta sign on CT scan Is suggested by palsies of the cranial nerves III, IV and VI Is less common post-partum than sagittal sinus thrombosis MRI has no role in its diagnosis

43 A B C D Answer

In regards to meningitis in children, which of the following is TRUE? In infants the most common cause is N. meningitidis In children under 15, N meningitidis group B is the most common cause The CSF is always abnormal in meningitis CSF protein is normally decreased

44 A B C D Answer

With Cerebral Lobe Dysfunction, which is TRUE? Gerstmann's Syndrome comprises parietal dominant signs of, dressing apraxia, acalculia and agraphia Astereognosis represents a dominant parietal lobe sign Receptive dysphasia occurs with a lesion in the dominant lobe posterior third of the frontal gyrus Nominal dysphasia occurs with a lesion in angular gyrus of the median temporal lobe

45 A B C D Answer

Which is TRUE regarding Guillain-Barre syndrome? EBV and CMV are thought to be the two major precipitants There are more cases in winter than summer The facial nerve is commonly involved Presentation is with a pure motor disturbance

46 A B C D Answer

Which is TRUE regarding Neisseria meningitidis meningitis? It is a Gram ve bacillus It is the commonest cause of meningitis in adults + children There are 3 known serogroups Humans are the only natural reservoir

47 A B C D Answer

Which of the following statements is TRUE with regards encephalitis? CMV can be treated with Aciclovir EEG can be diagnostic for VZV infection Unlike meningitis, infects both meninges and subarachnoid space Rabies virus travels within and via peripheral neurones to reach the brain

48 A B C D Answer

In hypersensitivity reactions Type 2 are immune complex mediated Post strep GN is an example of Type 2 reaction Anaphylactoid reactions are IgE mediated Mantoux test relies on Type 4 reactions

49 A B C D Answer

In regards to the NINDS trial, which is TRUE The NINDS study had a representative sample of patients The NINDS trial resulted in a significantly decreased mortality in the treatment group A modified Rankin score of 2 Slight disability but able to carry out usual activities was not considered a favourable outcome It is not resource intensive and should be reproducible by most EDs

50 A B C D Answer

With regard to cavernous sinus thrombosis which is CORRECT: Strep Pneumoniae is the causative organism in the majority of cases. Anticoagulation has no role to play in treatment Lumbar puncture will reveal CSF with elevated protein and WBC in most patients Contrast CT may show filling defect only

51 A B C D Answer

With regard to optic neuritis, which of the following is INCORRECT: Typically heralded by a dull retro-orbital ache, followed by monocular blurred vision over the next day. Associated with painless eye movements Central visual field defect is typical but there may be varying degrees of compromised visual acuity. An afferent papillary defect may be present.

52 A B C D Answer

What finding in a patient with facial muscle weakness suggests a diagnosis other than Bells palsy? Sparing of the frontalis muscle History of preceding respiratory infection Unilateral involvement Altered taste sensation

53 A B C D Answer

With respect to Bacterial meningitis Antibiotics should not be delayed for more than 90 minutes after initial assessment in suspected cases Amoxicillin and Gentamicin are recommended alternative antibiotics In the case of suspected Strep pneumoniae antibiotic resistance, Vancomycin is recommended Moxifloxacin is recommended as first line treatment

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 ABs, 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 31. D 32. B 33. B 34. D 35. D 36. C Dunn Dunn Shagreen in Tuberous Sclerosis and at lower back p236 Commonest in children 4-9 y.o Cameron (Paed) Cameron (Cameron says 20% of pts rebleed within first 2 weeks!) ACEM college guidelines EMP

37. C 38. A 39. D 40. B 41. A 42. B 43. B 44. D 45. C 46. D 47. D 48. D

Dunn page 527 Cameron (Paeds)Neurology, page 231 Dunn Dunn Stroke update 2007: Better Early Stroke Treatment (BEST). Emergency Medicine Dunn 4 Ed. Chapter 16: Neurology. 553 554. Cameron Paeds Dunn 4 Ed pages 510-511 Dunn 4 ed p 563 Dunn 4 ed p 540 A-Ganciclovir is used for CMV, B-EEG is pathognomonic for HSV, C-encephalitis is parenchymal infection, D-are you scratching yet, E- true!..Tintinalli. 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, esterase deficiency is not a hypersensitivity reaction, excess causes oedema. Dunn Mantoux. C1 bradykinin synthesis
rd th th th

Practice August 2007; 9(8).

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 51. B 52. A 53. C

EB Medicine An evidence based approach to Abnormal vision pp 15, 16. EB Medicine- An evidence Based approach to Abnormal Vision pp 13, 14.