Question 1

Which is NOT correct regarding migraines?

Accepted Answer

A)  Prevalence is higher in woman.
B)  Most improve during pregnancy
C)  It is idiopathic, and usually last less than 72 hrs.
D)  Ketorolac has been shown to be superior to chlorpromazine in the management of migraines.
E)  Sumatriptan is contraindicated in pregnancy. D

Question 2

Which is INCORRECT regarding myasthenia gravis?

Accepted Answer

A)  Onset in females usually 2nd and 3rd decades, males 7th and 8th decades.
B)  The thymus is abnormal in 75% and removal will improve symptoms in the majority.
C)  Acute crises in these patients can be due to myasthenia crisis or cholinergic crisis secondary to the medication.
D)  Muscle weakness is more marked peripherally.
E)  Diagnosis with Ach receptor antibody testing is possible but false negatives occur in 15%. D

Question 3

Which is INCORRECT regarding the aetiology of seizures?

Accepted Answer

A)  Idiopathic seizures usually start age 5-20 yrs.
B)  Post head trauma seizures usually begin within 2 years of trauma.
C)  Acute strokes are the most common cause in > 65 yr olds.
D)  Space occupying lesions account for 1% of new seizures age 35-65.
E)  Phenylketonuria may cause seizures. D

Question 4

Which is incorrect of seizures?

Accepted Answer

A)  There is decreased risk of seizures in pregnancy.
B)  Eclamptic seizures are typically brief, self-terminating preceded by headache and visual disturbances.
C)  Pseudo seizures are often recognized by pelvic thrusting which occurs in 45%.
D)  Classic ethanol withdrawal seizures occur 6-48 hrs post withdrawal but can occur up to one week after withdrawal.
E)  Seizures in HIV patients are usually secondary to intracranial pathology and all require urgent CT scan.

Question 5

What is the survival rate of a Hunt and Hess Grade 5 SAH?

Accepted Answer

A)  0%
B)  5%
C)  10%
D)  15%
E)  20%

Question 6

Which is INCORRECT regarding cerebral infarction?

Accepted Answer

A)  80% are MCA territory.
B)  MCA syndrome is usually embolic, and arm is usually more affected than leg.
C)  Lacunar infarcts usually have partial or complete recovery over 4-6 weeks.
D)  Lateral medullary syndrome can result in ipsilateral UMN 7, 9 & 10 CN palsy and Horner's syndrome with contralateral spinothalamic loss.
E)  Internuclear ophthalmoplegia usually results from anterior cerebral artery occlusion.

Question 7

Which of the following drugs is unlikely to cause seizure in withdrawal/

Accepted Answer

A)  Cocaine
B)  Narcotics
C)  Benzodiazepines
D)  Alcohol
E)  Tricyclics

Question 8

Which is INCORRECT regarding investigation of SAH?

Accepted Answer

A)  Non contrast CT becomes less sensitive with time following bleed.
B)  5-10% of patients with negative CT will have SAH.
C)  Presence of xanthochromia is the gold standard for diagnosing SAH on LP.
D)  Xanthochromia is present in all patients with SAH at 6 hrs post bleed.
E)  MRI angiography is not reliable enough to use for diagnosis and surgical planning of patients with proven SAH.

Question 9

Which is true of thrombolysis in cerebral infarct?

Accepted Answer

A)  Clear benefit has been shown in at least 2 randomized controlled trials that TPA reduces mortality in CVA.
B)  Patients up to 6 hrs post infarct have been shown to benefit from thrombolysis.
C)  Larger infarcts tend to have more benefit from thrombolysis.
D)  The NINDS trial showed that improvement in patients treated within 3 hrs with thrombolysis.
E)  ECASS trial thrombolysed patients within 3 hrs with TPA and showed improvements in all outcomes compared with placebo.

Question 10

Which is NOT true of non-traumatic subarachnoid haemorrhage?

Accepted Answer

A)  Most common in the 40-60 year age group.
B)  70% are due to AV malformations.
C)  Female: male = 2:1
D)  Smoking increases your risk 3-10 fold.
E)  50% of patients die or are permanently disabled from the initial event.

Question 11

Which is INCORRECT regarding the treatment of multiple sclerosis?

Accepted Answer

A)  Interferon and glatiramer have bee shown to reduce number of relapses in relapsingremitting MS.
B)  IV immunoglobulin monthly for 2 years has shown to reduce annual exacerbations in relapsing-remitting MS.
C)  No treatment currently exists for primary progressive MS to modify the disease.
D)  Exacerbations of MS are treated with methlypred IV as studies have shown this to be superior to other glucocorticoids.
E)  Symptomatic treatment of muscle spasticity is usually best achieved with baclofen.

Question 12

Which statement regarding central vertigo is incorrect?

Accepted Answer

A)  Cerebellar CVA's will often present with truncal ataxia.
B)  Vertebrobasilar insufficiency will produce vertigo lasting typically less than a few mins.
C)  Multiple sclerosis can cause vertigo which typically lasts a few mins and is recurring.
D)  Vertigo can be associated with migraines either as aura or part of the migraine.
E)  Wallenberg syndrome or lateral medullary infarction of brainstem is associated with vertigo and Horner's syndrome

Question 13

Which is NOT correct regarding temporal arteritis?

Accepted Answer

A)  Majority older than 50 yrs.
B)  More common in men.
C)  Ischaemic optic neuritis is most feared complication.
D)  Up to 50% of patients also have polymyalgia rheumatica.
E)  Jaw claudication in the history is highly suggestive of temporal arteritis.

Question 14

Which is INCORRECT regarding entrapment neuropathies?

Accepted Answer

A)  Carpal tunnel syndrome usually produces more pain at night.
B)  Bell's palsy cause sudden facial weakness with peak paralysis seen at 48 hrs.
C)  Use of steroids and acyclovir has been advocated for treatment of Bell's palsy as one study showed reduced length of paralysis.
D)  Entrapment of deep peroneal nerve will result in foot drop and paraesthesia between big toe and second toe.
E)  Ulnar nerve entrapment usually occurs at the wrist resulting in numbness of 5th digit and half of 4th digit.

Question 15

Which is incorrect regarding Guillain Barre Syndrome?

Accepted Answer

A)  80% of patients will have antecedent infection with Campylobacter jejuni.
B)  CSF will show low protein, high glucose and often a pleocytosis up to 100.
C)  High dose immune globulin and plasmapheresis have been shown to be equally efficacious in reducing length of illness.
D)  Severe cases will not only involve demyelination but also axonal degeneration.
E)  85% will recover to their previous normal functioning in one year.

Question 16

Which is true regarding the presentation of SAH?

Accepted Answer

A)  Up to 20% experience a sentinel bleed.
B)  A sixth cranial nerve palsy can represent a growing aneurysm in cavernous sinus.
C)  Seizures occur in 50% of patients.
D)  Photophobia is often more marked than patients with migraines.
E)  Syncope occurs in the minority of patients.

Question 17

Which statement is incorrect regarding treatment of seizures?

Accepted Answer

A)  Diazepam has the most rapid onset of the BDZ's.
B)  The LD of phenytoin needs to be decreased in renal impairment.
C)  Phenobarbital has duration of action of 3 days.
D)  Paraldehyde can be used rectally at a dose of 0.3mls/kg.
E)  Phenytoin is usually ineffective in seizures secondary to alcohol withdrawal or intoxication.

Question 18

Which is not an early sign of cerebral infarction on CT?

Accepted Answer

A)  Loss of cortical grey/white matter distinction.
B)  Effacement of cortical sulci
C)  Compression of ventricular system
D)  Hyper dense clot in MCA.
E)  All are possible early signs of infarct.

Question 19

Which is INCORRECT regarding treatment and complications of SAH?

Accepted Answer

A)  Nimodipine has only been proven to be of benefit orally in preventing vasospasm.
B)  10-30% of patients will rebleed, with 20% within the first 2 weeks.
C)  Vasospasm and delayed neurological deficit peak at day 1 post bleed.
D)  Hyponatremia is common due to excessive naturesis.
E)  The ECG often shows non-specific changes of widened QRS, prolonged QT and ST and T changes suggestive of ischaemia.

Question 20

Which statement is INCORRECT regarding multiple sclerosis?

Accepted Answer

A)  It is 2-3 times more common in females
B)  The most common reported symptom initially is sensory loss.
C)  Optic neuritis is usually unilateral can afferent pupillary response may be present.
D)  The majority of patients will show plaques on MRI T2 weighted scans.
E)  CSF often shows elevated protein, gamma-globulin and slightly elevated WCC.

Exam 1: Neurological Disorders