Internal Medicine/ Neurology

                                                                                                                             I.            CNS Anatomy.

1.    Anatomy.

***) One of the following is the twelfth cranial nerve: Q2012

A.    Accessory nerve

B.     Trigeminal nerve

C.     Glossopharyngeal nerve

D.    Hypoglossal nerve

E.     Vagus nerve

Answer: D* Hypoglossal nerve

***) Dysfunction of which of the following causes cortical blindness:

A.    Occipital lobes

B.     Temporal lobes

C.     Parietal lobes

D.    Frontal lobes

E.     Hypothalamus

Answer: A* Occipital lobes

***) All the following muscles are supplied by the trigeminal nerve except:

A.    Tensor veli palatini

B.     Tensor tympani

C.     Masseter

D.    Posterior belly of digastric

E.     Mylohyoid

Answer: D* Posterior belly of digastric

                                                                                 II.            Common CNS Presentations.

1.    Ptosis.

***) Ptosis is a feature of all the following except: Q2012

A.    Myotonic dystrophy

B.     Horner syndrome

C.     Oculomotor nerve palsy CN III

D.    Abducens nerve palsy CN VI

E.     Myasthenia gravis

Answer: D* Abducens nerve palsy CN VI

2.    Marfan syndrome.

***) 22 years old male has feature of arm span greater than height, subluxed lenses, flattened corneas, and dilation of the aortic ring. The most likely diagnosis is: Q2012

A.    Ehlers-Danlos syndrome

B.     Marfan syndrome

C.     Werner's syndrome

D.    Laurence-Moon-Biedl syndrome

E.     Hunter's syndrome

Answer: B* Marfan syndrome

3.    Aphasia.

***) 65 years old male with DM and HTN, develops acute right sided hemiplegia, on examination he has intact comprehension, can obey commands but unable to speak or repeat phrases. His language disturbance represents one of the following: Q2012

A.    Receptive aphasia

B.     Expressive aphasia

C.     Global aphasia

D.    Anomic aphasia

E.     Cerebellar aphasia

Answer: B* Expressive aphasia

4.    Tremor.

***) All of the following are causes of tremor, except:

A.    Parkinsonism

B.     Familial

C.     Hypoglycemia

D.    Anxiety

E.     Hyperparathyroidism

Answer: E* Hyperparathyroidism

***) Tremor may be seen in all of the following conditions, except:

A.    Hyperthyroidism

B.     Respiratory failure

C.     Hepatic failure

D.    Parkinson's disease

E.     Depression

Answer: C* Hepatic failure

5.    Chorea.

***) All of the following are causes of chorea, except:

A.    Rheumatic fever

B.     Huntington's disease

C.     Carbamazepine

D.    Polycythemia rubra vera

E.     Pregnancy

Answer: D* Polycythemia rubra vera

***) All of the following are causes of chorea, except:

A.    Rheumatic fever

B.     Pregnancy

C.     Contraceptive pills

D.    Multiple sclerosis

E.     Systemic lupus erythematosus

Answer: D* Multiple sclerosis

6.    Pupillary Abnormalities.

***) Pinpoint pupils are seen in all the following, except: Q2012

A.    Organophosphorus poisoning

B.     Opiates overdose

C.     Pontine hemorrhage

D.    Subarachnoid hemorrhage

E.     Insecticide intoxication

Answer: D* Subarachnoid hemorrhage

***) Causes of small pupils include all of the following, except:

A.    3^rd cranial nerve palsy

B.     Horner's syndrome

C.     Pontine hemorrhage

D.    Tabes dorsalis

E.     Organophosphorus poisoning

Answer: A* 3^rd cranial nerve palsy

7.    Papilledema.

***) False statement about papilledema:

A.    It takes usually 24-48 hours to develop but can occur as early as 6 hours

B.     Caused by axoplasmic stasis

C.     Does not affect visual acuity unless the macula area is affected by hemorrhage

D.    Never seen unilaterally

E.     Papillitis gives similar findings on clinical examination

Answer: D* Never seen unilaterally

***) Causes of papilledema include all of the following, except:

A.    Raised intracranial pressure

B.     Hypertension

C.     Addison's disease

D.    Acromegaly

E.     Carbon dioxide retention

Answer: C* Addison's disease

***) All of the following are causes of papilledema, except:

A.    Intracranial mass lesions

B.     Subarachnoid hemorrhage

C.     Benign intracranial hypertension

D.    Accelerated hypertension

E.     Vitamin B₁₂ deficiency

Answer: E* Vitamin B₁₂ deficiency

8.    Upper motor neuron lesion.

***) Pyramidal tract lesion can produce all the following except: Q2012

A.    Spasticity

B.     Fasciculation

C.     Weakness

D.    Hyperreflexia

E.     Positive Babinski sign

Answer: B* Fasciculation

***) Upper motor neuron lesion can produce all the following except:

A.    Increased deep tendon reflexes

B.     Extensor plantar response

C.     Muscle weakness

D.    Fasciculation

E.     Spasticity

Answer: D* Fasciculation

***) All of the following are signs of upper motor neuron lesion, except:

A.    Increase in tone

B.     Hyperreflexia

C.     Fasciculation

D.    An extensor plantar reflex

E.     Pyramidal weakness

Answer: C* Fasciculation

***) Signs of upper motor neuron lesion include all of the following, except:

A.    Hypertonia

B.     Clonus

C.     Pyramidal weakness

D.    Hyperreflexia

E.     Marked fasciculation

Answer: E* Marked fasciculation

9.    Lower motor neuron lesion.

***) Signs of lower motor neuron lesion include all of the following, except:

A.    Muscular weakness

B.     Atonia

C.     Fasciculation

D.    Clonus

E.     Atrophy

Answer: D* Clonus

***) The following are signs of lower motor neuron lesion, except:

A.    Weakness

B.     Wasting

C.     Fasciculation

D.    Hypertonia

E.     Decreased reflexes

Answer: D* Hypertonia

***) All of the following are signs of a lower motor neuron lesion, except:

A.    Hypotonia

B.     Reflex loss

C.     Muscle wasting

D.    Extensor plantar reflex

E.     Fibrillation

Answer: D* Extensor plantar reflex

***) All of the following are signs of a lower motor neuron lesion, except:

A.    Fibrillation

B.     Fasciculation

C.     Spasticity

D.    Muscle wasting

E.     Hyporeflexia

Answer: C* Spasticity

10.           Headaches.

***) All the followings regarding headache is true, except:

A.    It may be caused by temporal arteritis

B.     It may be secondary to benign intracranial hypertension

C.     Tension headache is common

D.    It occurs usually in the evening when it is due to brain tumor

E.     It may be secondary to hypertension

Answer: D* It occurs usually in the evening when it is due to brain tumor

***) The following statements regarding cluster headache are true, except:

A.    Affects approximately 0.1% of the population

B.     More common in females

C.     Similar to migraine, may have a familial predisposition

D.    The attack is often associated with autonomic features

E.     It has two forms, episodic and chronic

Answer: B* More common in females

11.           Weak Legs & Cord Compression.

***) Foot drop is commonly caused by compression of which of the following:

A.    Sciatic nerve

B.     Posterior tibial nerve

C.     Common peroneal nerve

D.    Sural nerve

E.     Obturator nerve

Answer: C* Common peroneal nerve

***) High steppage gait can be seen in all of the following, except:

A.    Guillain-Barre syndrome

B.     Hereditary motor sensory neuropathy

C.     Lead poisoning

D.    Vitamin B₁₂ deficiency

E.     Folic acid deficiency

Answer: E* Folic acid deficiency

                                                                                III.            CNS Vascular Phenomena.

1.    Stroke.

***) Predisposing factors for the development of stroke include all of the following, except:

A.    Hypertension

B.     Hyperlipoproteinemia

C.     Diabetes mellitus

D.    Anemia

E.     Atrial fibrillation

Answer: D* Anemia

***) In adult cerebral embolism is commonly caused by:

A.    Heart disease

B.     Air embolism

C.     Neoplastic thrombi

D.    Fat emboli secondary to fracture

E.     Septic pulmonary disease

Answer: A* Heart disease

                                                                                                                      IV.            CNS Diseases.

1.    Delirium.

***) All of following can cause confusion, except:

A.    Meningitis

B.     Subdural hematoma

C.     Hypertensive encephalopathy

D.    Cerebrovascular accident

E.     Multiple sclerosis

Answer: E* Multiple sclerosis

2.    Epilepsy.

***) Causes of epileptic fits include all of the following, except:

A.    Head injury

B.     Brain tumor

C.     Hypoglycemia

D.    Hypercalcemia

E.     Systemic lupus erythematosus

Answer: D* Hypercalcemia

***) Causes of epilepsy include all of the following, except:

A.    Cerebrovascular accident

B.     Encephalitis

C.     Head injury

D.    Acute bronchopneumonia

E.     Brain abscess

Answer: D* Acute bronchopneumonia

***) All the following are anti-epileptic drugs, except:

A.    Phenytoin

B.     Carbamazepine

C.     Lamotrigine

D.    Valproate

E.     Dipyridamole

Answer: E* Dipyridamole

***) In the management of status epilepticus is the first step is:

A.    Diazepam IV

B.     Phenytoin IV

C.     Open airways

D.    Hypertonic glucose IV

E.     Phenobarbital IV

Answer: C* Open airways

***) The drug of choice in status epilepticus is IV:

A.    Succinylcholine

B.     Diazepam

C.     Lidocaine

D.    Meprobamate

E.     Morphine

Answer: B* Diazepam

***) Side effects of phenytoin (Epanutin) include all of the following, except:

A.    Hypertrophy of the gums

B.     Anemia

C.     Ataxia

D.    Pseudolymphoma

E.     Benign intracranial hypertension

Answer: E* Benign intracranial hypertension

***) Weight gain is a known complication of one for the following drugs:

A.    Sodium valproate

B.     Tetracycline

C.     Topiramate

D.    Neurontin

E.     Penicillamine

Answer: A* Sodium valproate

3.    Parkinson's disease.

***) All of the following are clinical features of Parkinson's disease, except:

A.    Causes tremor

B.     Hypokinesis

C.     Mask face

D.    Respond to bromocriptine

E.     Bilateral extensor plantar reflex

Answer: E* Bilateral extensor plantar reflex

***) All of the following are clinical features of Parkinson's disease, except:

A.    Pill-rolling tremor

B.     Lead-pipe rigidity

C.     Aphasia

D.    Bradykinesia

E.     Shuffling gait

Answer: C* Aphasia

***) All of the following are clinical features of Parkinson's disease, except:

A.    Rigidity

B.     Tremor

C.     Hypokinesis

D.    Extensive sensory loss

E.     Expressionless face

Answer: D* Extensive sensory loss

4.    Multiple Sclerosis.

***) The following about multiple sclerosis are true, except:

A.    Causes paresthesia

B.     Diplopia is a feature

C.     Is a remitting and relapsing disease

D.    Causes urinary symptoms

E.     More common in elderly

Answer: E* More common in elderly

***) One of the followings is a good prognostic factor for multiple sclerosis:

A.    Male gender

B.     Presence of motor and cerebellar symptoms

C.     Severe disability after the first attack

D.    Presentation with optic neuritis and sensory symptoms

E.     Numerous relapses within the first year negatively influence the clinical

Answer: D* Presentation with optic neuritis and sensory symptoms

5.    Peripheral Neuropathies.

***) All of the following can cause peripheral neuropathy, except:

A.    Lead poisoning

B.     Diphtheria

C.     Guillain-Barr syndrome

D.    Vitamin B₁₂ deficiency

E.     Vitamin C deficiency

Answer: E* Vitamin C deficiency

***) Causes of peripheral neuropathy include all of the following, except:

A.    Diabetes mellitus

B.     AIDS

C.     B₁₂ deficiency

D.    Systemic lupus erythematosus

E.     Iron deficiency anemia

Answer: E* Iron deficiency anemia

***) Causes of mononeuritis multiplex include all of the following, except:

A.    Sarcoidosis

B.     Diabetes mellitus

C.     Polyarteritis nodosa

D.    Rheumatoid arthritis

E.     Vitamin B₁₂ deficiency

Answer: E* Vitamin B₁₂ deficiency

***) In carpal tunnel syndrome the nerve compressed is the: Q2012

A.    Ulnar

B.     Radial

C.     Median

D.    Musculocutaneous

E.     Posterior interosseous

Answer: C* Median

***) In carpal tunnel syndrome the nerve compressed is the:

A.    Ulnar

B.     Radial

C.     Median

D.    Musculocutaneous

E.     Posterior interosseous

Answer: C* Median

***) Regarding carpal tunnel syndrome which is the true statement:

A.    It is the most common peripheral nerve entrapment syndrome

B.     Typical symptoms consist of dysesthesias, weakness, and decreased sensation

C.     The area over the median nerve at the wrist produces paresthesia in the median nerve

D.    Other muscles that show some weakness include the lateral two lumbricals

E.     All of the above

Answer: E* All of the above

***) Causes of carpal tunnel syndrome occur in all of the following, except:

A.    Primary amyloidosis

B.     Myxedema

C.     Rheumatoid arthritis

D.    May be idiopathic

E.     Ankylosing spondylitis

Answer: E* Ankylosing spondylitis

***) Causes of carpal tunnel syndrome include all of the following, except:

A.    Pregnancy

B.     Myxedema

C.     Multiple sclerosis

D.    Acromegaly

E.     Rheumatoid arthritis

Answer: C* Multiple sclerosis

***) The skin overlying the hypothenar muscle of the palm is supplied by the:

A.    Radial nerve

B.     Median nerve

C.     Ulnar nerve

D.    Anterior interosseous nerve

E.     Superficial radial nerve

Answer: C* Ulnar nerve

***) Partial clawing of the hand is the manifestation of injury one of the following:

A.    Ulnar nerve

B.     Radial nerve

C.     Median nerve

D.    Anterior interosseous nerve

E.     Musculocutaneous nerve

Answer: A* Ulnar nerve

***) A patient presents with wasting of small muscles of hand with thenar sprain. What is the most probable nerve could be affected:

A.    Ulnar nerve

B.     Median nerve

C.     Axillary nerve

D.    Musculocutaneous nerve

E.     Thenar nerve

Answer: A* Ulnar nerve

***) Regarding Erb's palsy all is true except:

A.    It is an injury to the upper brachial plexus (C5 - C6)

B.     Usually results from separation or stretch of the neck and shoulder

C.     Distal strength in the upper extremity is always reduced

D.    The arm may be held in adduction with the fingers pointing backward

E.     C5 & C6 dermatomes reduced sensation and paralysis of scapular muscles

Answer: C* Distal strength in the upper extremity is always reduced

6.    Myasthenia Gravis.

***) The lesion of myasthenia gravis is in the:

A.    Anterior horn cell

B.     Neuromuscular junction

C.     Sensory ganglia

D.    Parasympathetic ganglia

E.     Sympathetic chain

Answer: B* Neuromuscular junction

***) All of the following about myasthenia gravis are true, except:

A.    Causes ptosis

B.     Weakness is usually proximal

C.     Recognized cause of respiratory failure

D.    Anticholinesterase therapy is harmful

E.     Can cause bulbar muscle weakness

Answer: D* Anticholinesterase therapy is harmful

***) All of the following features of myasthenia gravis are true, except:

A.    Asymmetrical weakness

B.     Associated with thyrotoxicosis

C.     Dysphagia

D.    Absence reflexes

E.     Natural remission

Answer: D* Absence reflexes

***) The surgical treatment of myasthenia gravis is:

A.    Bilateral adrenalectomy

B.     Hypophysectomy

C.     Thymectomy

D.    Total thyroidectomy

E.     Splenectomy

Answer: C* Thymectomy

7.    Horner's Syndrome.

***) Findings in Horner's syndrome include:

A.    Miosis

B.     Anhidrosis of half of face

C.     Enophthalmos

D.    Ptosis

E.     All of the above

Answer: E* All of the above

***) Features of Horner's syndrome include all of the following, except:

A.    Partial ptosis

B.     Enophthalmos

C.     Constricted pupil

D.    Decreased sweating in the ipsilateral half of the face

E.     Abducted eye

Answer: E* Abducted eye

***) Which one of the following tumors may be associated with Horner's syndrome:

A.    Pancoast tumor

B.     Main bronchus carcinoma

C.     Carcinoma of the lower third of the esophagus

D.    Carcinoid tumor

E.     Hepatoma

Answer: A* Pancoast tumor