Neurology 4 mrcp questions book - part 7 pps

4- Primary spinal tumors are the commonest causes. 5- CSF protein is usually very high. Q30: Paraplegia, all of the followings are true causes, except: 1- Parasaggittal meningioma. 2- Transverse myelitis at T6 level. 3- Spinal cord trans-section at the dorsal spine. 4- Acute anterior spinal artery occlusion at the dorsal spine. 5- Gun shot injury at the cauda equine. Q31: Hemi section of the spinal cord; all of the following findings are true, except: 1- ipsilateral up going toe at the side of the lesion. 2- Ipsilateral loss of vibration below the level of the lesion 3- Ipsilateral loss of pain and temperature sensations below the level of the lesion 4- Ipsilateral area of dysthesia on the trunk at the level of the lesion 5- Ipsilateral lower motor neuron lesion at the level of the lesion Q32: Syringomyelia, all of the followings are true, except: 1- Muscle wasting is usually asymmetrical to start with in both upper limbs. 2- Trophic changes are prominent in full blown picture. 3- Dissociated sensory loss. 4- Tongue involvement indicates lower brain stem involvement. 5- Usually it has a very rapid progression. Q33: Dementias in general, all of the followings are true, except: 1- Alzheimer’s disease is the commonest cause. 2- Up to 20% of people above the age of 80 years have some form of dementing illness. 3-Viotmain B12 deficiency is a potentially reversible cause. 4- All patients will Down's syndrome will develop an Alzheimer’s type dementia by the age of 40 years. 5- Prominent formed visual hallucinations are in favor of Picks type dementia. Q34: Causes of proximal symmetrical myopathy, all of the followings are true, except: 1- Hypothyroidism. 2- Chronic alcoholism. 3- Cushing‘s disease. 4- Osteomalacia. 5- Diabetes mellitus. Q35: Duchenne muscular dystrophy, all of the followings are true, except: 1- Usually presents between the ages of 3-5 years. 2- There may be enlargement of the calves. 3- The CPK is high even from birth. 4- The commonest cause of death is cardiac problems. 5- Some mental abnormality is seen up to 20% of cases. Q36: Management of myasthenia gravis, all of the followings are true, except: 1-Puppilary constriction in the context of profound life threatening weakness may be a clue to cholinergic crises. 2- Propantheline is usually given 3-6 times daily to combat the side effects of pyridostigmine. 3- Thymectomy is indicated in all cases. 4- The presence of thymoma portends a poor prognosis. 5- During a suspected myasthenic crisis, we should stop all medication if we can. Q37: Guilllain Barre syndrome, all of the followings are true, except: 1- Usually preceded 1-4 weeks by an upper respiratory tract or GIT infection. 2- Pure axonal type is seen and carries a poor prognosis. 3- 20% of patients will need mechanical ventilation. 4- Facial weakness is seen in 50% of cases. 5- Dysautonomia is seen in 6% of cases. Q38: Clues to peripheral neuropathy, all of the followings are true, except: 1- Blood picture showing basophilic stippling- lead poisoning. 2- Psychosis and abdominal pain- acute intermittent porphyria. 3- Prominent postural hypotension and nephrotic syndrome- primary AL amyloidosis. 4- Hoarse voice–hyperthyroidism. 5- Painful burning feet- alcoholism. Q39: Carpal tunnel syndrome, all of the followings are true, except: 1- May be diagnosed during pregnancy. 2- Pain, but not parasthesias, may radiate up the arm. 3- Diabetes mellitus is a risk factor. 4- In up to 50% of cases the nerve conduction study and EMG are totally normal. 5- The face of the patient may give a clue to the underlying cause of it. Q40: Chronic subdural hematoma, all of the followings are true, except: 1- In 25-50% of cases, no history of head trauma can be obtained. 2- Mainly seen in elderly people and alcoholics. 3- After 4 weeks, the hematoma becomes darker than the brain. 4- The source of bleeding is an arteriolar one. 5- Some hematomas gradually expand. Subchapter: B Q1: Alzheimer's disease, which is the wrong statement? a- it is the commonest cause of dementia with a prevalence of 10-20 million cases world wide. b- men and women are affected with equal frequency. c- abnormal metabolism and deposition of beta-amyloid protein appears to be closed linked to its pathogenesis. d- it is usually inherited on genetic basis. e- neuropathologically, there are neuritic plaques and neurofibrillary tangles. Q2: Alzheimer's disease, which is the wrong statement? a- patients with Down's syndrome have a very high incidence of developing Alzheimer's disease. b- familial Alzheimer's diseases are autosomal dominant linked to chromosomes 1 and 14 . c-the number of APOE4 allels on chromosome 19 may influence the disease development. d- abnormal cleavage of amyloid precursor protein (APP) by alpha, beta and gamma secretases is one of the presumed pathophysiological mechanisms. e- choline acyltransferase is markedly increased in the cortex and hippocampus of patients with Alzheimer's disease. Q3: Alzheimer's disease, which is the wrong statement? a- there is prominent degeneration of the nucleus basalis of Meynert and of cholinergic septal-hippocampal tract. b- APOE4 polymorphism increases the susceptibility to Alzheimer's disease. c- various missense mutations in APP gene on chromosome 21 may cause familial Alzhiemer's disease. d- various missense mutations in PS2 gene in chromosome 1 is responsible for the development of early onset Alzheimer's disease in Volga Germans. e- Down's syndrome patients are protect against the development of Alzheimer's disease. Q4: Early manifestation of Alzheimer's disease, which is the wrong statement? a- impairment of recent memory is typically the first sign of the disease. b- gradually the patient becomes disoriented to time. c- aphasia , anomia and acalculia are very rare. d-a frontal gait disorder may be seen early. e- visuo-spatial disorientation can be seen early in the course. Q5: Late manifestation of Alzheimer's disease, which is the wrong statement? a- seizures occur in some cases. b- there might be frank psychosis with paranoia and hallucinations. c- rigidity and bradykinesia are late features. d- mutisim, incontinence and bed-ridden state indicate a terminal situation. e- death typically occurs 1-2 years after the onset of symtoms. Q6: Medical treatment of Alzheimer's disease, which is the wrong statement? a- nowadays, there are many medications that can reverse or arrest the progression of the disease. b- acetyl cholinesterase inhibitors have been shown to produce small improvement in the tests if cognitive function. c-of all acetyl cholinesterase inhibitors, donepezil is now the agent of choice. d- alpha tocopherol and selegilin have been shown to be of small benefit in Alzheimer's disease. e- behavioral disturbances can be controlled by antipsychotics, antidepressents or anxiolytics. Q7: Prognosis of Alzheimer's disease, which is the wrong statement? a- early in the course, the patient can usually remain at home. b- in advanced cases ,the patient usually needs special care in a nursing facilities. c- the patient should be protected from injuring himself and his family. d- death usually occurs 5-10 years after the onset of symptoms. e- the usually cause of death is myocardial infarction. Q8: Pick's frontotemproal dementia rather that Alzheimer's disease ,is suggested by all of the followings except ? a- earlier age of onset. b- more prominent behavioral than cognitive dysfunction at presentation. c- MRI showing preferential atrophy pf anterior temporal frontal lobes. d- the presence of Pick's cells and Pick's inclusion bodies on biopsy specimen. e- the presence of prominent neuritic plaques and neurofibrillary tangles. Q9: Creutzfeldt-Jacob disease, which is the wrong statement? a- invariably fatal transmissible disorder of the central nervous system. b- the annual incidence is 1:1000000 population. c- the naturally acquired disease occurs in patients 16-82 years of age. d- affects both sexes equally. e- more thanone member of a family is affected in up to 90% of cases. Q10: Creutzfeldt-Jacob disease, which is the wrong statement? a- transmission from humans to animals has been demonstrated. b-the infectious agent is present in all body fluids. c- familial cases are due to mutation in the prion protein-cellular isoform. d- the normal prion protein-cellular isoform differs from the abnormal prion protein- scrapie-isoform in the secondary folding structure only. e- prominent autonomic and endocrine disorders are against the diagnosis. Q11: Creutzfeldt-Jacob disease (CJD) , which is the wrong statement? a- dementia is present virtually in all cases. b- focal cortical signs like aphasia and apraxia may be seen early. c- psychiatric, behavioral and personality changes are common. d- aside from cognitive abnormalities, the most frequent clinical manifestation is myoclonus. e- progression to akinetic mutism or coma typically ensues over a period of many years. Q12: Creutzfeldt-Jacob disease (CJD) , which is the wrong statement? a- the EEG may show periodic sharp waves or spike in 65% of cases. b- MRI of the brain may show hyper-intense lesions in the basal ganglia. c- the levels of protein 14-3-3 are markedly decreased in the CSF. d- in familial cases ,definitive diagnosis can be done by detection of the mutant form of PrPc in DNA from peripheral blood lymphocyte. e- the CSF protein may be elevated. Q13: Creutzfeldt-Jacob disease (CJD), which is the wrong statement? a- should be differentiated from Alzheimer's disease. b- might be confused with Parkinson's disease or progressive surpranuclear palsy. c- intracerebral mass lesion may simulate it. d- it is invariably fatal disease. e- death usually occur with 10 year after the onset of symptoms. Q14: Normal pressure hydrocephalus, which is the wrong statement? a- a potentially reversible cause of dementia. b- it might be idiopathic . c- the dementia is usually severe and rapidly progressive. d- aphasia and agnosias are rare. e- it is supposed to be due to impaired absorption of the CSF at the level of arachnoid granulation over the cerebral convexities. Q15: Normal pressure hydrocephalus, which is the wrong statement? a- usually develops over a period of weeks to months. b- the initial abnormality is usually gait apraxia. c- urinary incontinence is a late development. d- pyramidal signs are very common. e- motor perseveration and grasp reflex in the hands and feet may occur. Q16: Normal pressure hydrocephalus, which is the wrong statement? a- the CSF opening pressure is usually elevated. b- Brain CT scan usually shows dilated ventricles without cortical atrophy. c- radionuclide cisternography classically reveals isotop accumulation in the ventricles. d- transient improvement following removal of 50 ml of CSF at lumbar puncture is the best predictor of a favorable clinical response to shunting. e- complications of shunting unfortunately occur in 1/3rd of cases. Q17: Dementia with Lewy bodies, which is the wrong statement? a- it is the 2 nd commonest cause of dementia. b- Lewy bodies are present in the cerebral cortex and brain stem. c- Lewy bodies contain alpha-synnuclein only. d- dementia with Lewy bodies is found in patient with and without histological features of Alzheimer's disease. e- In contrast to Alzheimer's disease, it is characterized by cognitive decline with a prominent early loss of recent memory. Q18: Characterisitic features of dementia with Lewy bodies, which is the wrong statement? a- fluctuating cognitive function. b- visual hallucinations. c- Parkinsonism. d- may respond to donepezil. e- high response rate to antipsychotics. Q19: Brain tumors-associated dementia, which is the wrong statement? a- might be due to brain edema, compression of adjacent brain structures, raised intracranial pressure and impairment of cerebral blood flow. b- the tumor most likely producing this picture is of the pituitary gland. c- this type of dementia is characterized by mental slowness and apathy. d- there might be associated agnosias or aphasia . e- seizures might be seen. Q20: AIDS-dementia complex, which is the wrong statement? a- it is the commonest neurological complication of AIDS. b- it might be the presenting feature of AIDS. c- it results from invasion of the brain with HIV-1 early in the course after acquisition of the virus. d- HIV-1 replicates in neurons and glia of the brain with resulting neuronal death. e- might be preceded by a history of symptomatic HIV-1 meningitis. Q21: AIDS-dementia complex, which is the wrong statement? a- the onset is usually rapidly progressive with prominent agitation. b- examination may reveal cerebellar ataxia and extensor planters. c- fecal and urinary incontinence are late features. d- organic psychosis is common lately in the course. e- myoclonus and seizures can be prominent . Q22: AIDS-dementia complex, which is the wrong statement? a- MRI may reveal diffuse cortical atrophy. b- in 20% of cases there is mild mononuclear pleocytosis in the CSF. c- CSF oligoclonal bands might be seen. d- HIV serology are positive. e- CSF protein is elevated in 10% of case only. Q23: General paresis of insane (GPI), which is the wrong statement? a- it is a chronic meningo-encephalitis caused by active spirochetal infection of the brain. b- the onset is usually gradual with memory loss, altered affect or vague personality changes. c- incontinence ,seizures and stroke are very common early feature. d- there is trombone tremor of the face and tongue. e- pyramidal signs and paucity of facial features are common. Q24: Prognosis General Paresis of Insane (GPI) after receiving penicillin, which is the wrong statement? a- the clinical condition may improve. b- asymptomatic patients with persistent CSF abnormalities should be not be retreated. c- patients with symptomatic progression should be retreated. d- patients with reactive CSF syphilis serology but without pleocytosis are unlikely to respond to penicillin. e- patients with reactive CSF syphilis serology but without pleocytosis should receive treatment. Q25: Progressive multi-focal encephalopathy, which is the wrong statement? a- results from infection with a papovavirus . b- most healthy adults are sero-positive for this virus. c- the virus infects the cortical neurons . d- the course of the disease is subacute. e- the disease rarely symptomatic in those with intact immune functions. Q26: Progressive multi-focal encephalopathy, which is the wrong statement? a- fever and systemic features are absent. b- dementia is prominent. c- hemiparesis, visual field defects and aphasia are very common and prominent. d- ataxia and headache are uncommon. e- seizures are very commonly seen. Q27: Progressive multi-focal encephalopathy, which is the wrong statement? a- the CSF is usually normal. b- MRI study usually shows diffuse white matter abnormalities. c- definitive diagnosis is usually done by brain biopsy. d- the disorder is fortunately rarely fatal. e- treatment with cytosine arabinocide is unsuccessful. Q28: Marchiafava Bignami syndrome, which is the wrong statement? a- characterized by necrosis of the corpus callosum and subcortical white matter in malnourished alcoholics. b- the course could be acute, subacute or chronic. c- characterized by dementia, spasticity, gait disorders. d- no specific treatment is available. e- virtually all patients will die. Q29: Dialysis dementia, which is the wrong statement? a- it is seen uremic patients on chronic long term hemodialysis. b- caused by gradual accumulation of aluminum in the body. c- the classical features are dementia, myoclonus, seizures and dysarthria. d- the EEG shows paroxysmal high voltage slowing with intermixed spikes and slow waves. e- the incidence is gradually increasing. Q30: Non-Wilsonian hepatocerebral degeneration, which is the wrong statement? a- it is an uncommon complication of hepatic cirrhosis. b- the syndrome is usually fluctuating but progressive over 1-9 years. c- dementia is characterized by mental slowness , apathy, impaired concentration and memory disturbance. d- pyramidal, extrapyramidal and cerebellar signs are common. e- CSF polymorphonuclear pleocytosis is very common. Q31: Chronic subdural hematoma-associated dementia, which is the wrong statement? a- usually seen in old people following a minor head truma. b- the hematoma is bilateral in 1/6 th of cases. c- the symptoms may be delayed for several weeks or months after development of hematoma. d- headache is usually the last symptom. e- the classical presentation is with cognitive disturbance, hemiparesis, papilleodema and extensor planters. Q32: Vascular dementia, which is the wrong statement ? a- it is the 3 rd commonest cause of dementia. b-those patients either have multiple large cortical infarcts or multiple small deep lacunar infacrts . c- the relationship of the cerebrovascular disease and the development of dementia is poorly characterized. d- the majority of patients are normo-tensive. e- the onset may be more or less abrupt. Q33: Vascular dementia, which is the wrong statement? a- pseudobulbar palsy is very common. b- there is focal sensori-motor deficits with ataxia and gait apraxia. c- MRI is less sensitive than CT scan at detecting the brain abnormalities. d- a search for vasculitis and meningovascular syphilis should be done in younger patients. e- antiplatelet agents are usually given. Q34: Pseudo-dementia, which is the wrong statement? a- depression is the commonest disorder mistaken for dementia. b- depression can be a feature of dementia and both disorders often coexist. c- prominent vegetative symptoms are in favor of dementia. d- somatic complaints are uncommon in dementia . e- cognitive impairment that is more prominent at night is in favor of dementia . Subchapter: C Q1: Head trauma associated amnesia, which is the wrong statement? a-head traumas causing loss of consciousness always result in an amnestic syndrome. b-features of transient global amnesia may be seen. c-retrograde amnesia may bee seen. d-anterograde amnesia is not seen. e-after the head injury, the patient may behave normally in an automatic fashion. Q2: Cerebral hypoxia and ischemia- associated amnesia, which is the wrong statement? a-such an amnesia tends to occur in those who are in coma for more than 12 hours. b-mainly attributed to damage in the pyramidal neurons of the hippocampus in the Sommer sector of the hippocampus. c-there is severe impairment in the formation of new memories with relative preservation of registration. d-the patient may sometimes confabulate. e-characteristically ,retrograde amnesia is not seen. Q3: Cerebral hypoxia and ischemia- associated amnesia, which is the wrong statement? a-it may be the sole manifestation following a cardiac arrest event. b-following a cardiac arrest, this syndrome may coexist with cerebral watershed syndromes. c-recovery from this amnestic syndrome often occurs within several days. d-carbon monoxide poisoning associated -amnestic syndromes are frequently associated with prominent affective disturbances. e-in carbon monoxide poisoning associated -amnestic syndromes the brain CT scan usually shows hyperdense areas in the frontal cortex. Q4: Bilateral cerebral artery occlusion-associated amnesia, which is the wrong statement? a- bilateral cerebral artery occlusion associated-amnestic syndrome may be a transient or a permanent one. b-usually caused by emboli to the internal carotid arterial system. c-the resulting amnestic syndrome may be associated with unilateral or bilateral hemianopia. d-signs of upper midbrain dysfunction may be prominent. e-recent memory tends to be affected with relative preservation of remote memory and registration. Q5: Transient global amnesia (TGA), which is the wrong statement? a-it is an acute memory loss seen in middle aged people. b-most patients will have recurrent attacks. c-during the attack, knowledge of personal identity is characteristically preserved. d-retrograde amnesia preceding the attack for a variable period may be seen. e-during the attack, new memories can not be formed. Q6: Transient global amnesia (TGA), which is the wrong statement? a-during the spell, the patient appears to be perplexed and confused. b-unfortunately, the condition may be diagnosed as a psychogenic disturbance. c-all patients are completely healthy prior to the spells. d-CT scan may show abnormalities in the temporal lobes during the spells. e-diffusion-weighted MRI may show signal abnormalities during the spells. Q7: Alcoholic blackouts, which is the wrong statement? a-caused by short term consumption of large amount of ethanol by chronic alcoholics. b-defined as an acute amnestic syndrome that is not due to global confusion, seizures, head trauma, or Wernicke's encephalopathy. c-there is prominent inability to form new memories. d-may result from ethanol induced depression of synaptic neurotransmission. e-necessitates treatment with long term chlordiazepoxide tablets. Q8: Dissociative amnesia, which is the wrong statement? a-characterized by an isolated or a disproportionate loss of traumatic or stressful personal memories. b-usually localized in time to the immediate aftermath of a traumatic experience. c-in some cases ,the patients may be unable to remember their own name. d-recent memory is prominently affected. e-examination under hypnosis may helpful in establishing that the amnesia is psychogenic in origin. Q9: Alcoholic Korsakoff's amnestic syndrome, which is the wrong statement? a-usually preceded by one or more episodes of Wernicke's encephalopathy. b-the associated memory disorder is thought to be due to degeneration of the dorso- medial thalami. c-often associated with peripheral polyneuropathy. d-the classical defect is an impairment of recent memory and failure to form new ones. e-the patient is characteristically agitated and has insight to his illness. Q10: Post-encephalitic amnesia, which is the wrong statement? a-following encephalitis, the patient may be left with a permanent and static and amnestic syndrome. b-confabulation are never seen. c-symptoms of limbic system disease may be prominent. d-complex partial seizures may be seen. e-the commonest cause of this syndrome is herpes simplex encephalitis. Q11: Brain tumor associated amnestic syndrome, which is the wrong statement? a-it is a very common type of amnestic syndromes. b-tumors that produce this syndrome include those that are located within the 3 rd ventricles. c-the amnestic syndrome resemble that of alcohol Koraskoff's one. d-deep midline tumors often produce prominent lethargy and headache. e-treatment depends on the underlying tumor type and location. Q12: Paraneoplastic limbic encephalaitis, which is the wrong statement? a-it is an autoimmune inflammatory and degenerative disease that affects the gray matter of the limbic system. b-usually associated with small cell carcinoma of the lung. c-neuropathologically, there is neuronal loss, reactive gliosis, microglial proliferation, and perivascular lymphocytic cuffing. d-affective symptoms like depression or anxiety are rare late features. e-the manestic syndrome resembles that of alcohol Korsakoff's one. Q13: Paraneoplastic limbic encephalaitis, which is the wrong statement? a-the CSF may show an elevated protein and mild mononuclear pleocytosis. b-EEG may show diffuse slowing or bitemporal slow wave and spikes. c-brain MRI may show signal abnormalities in the occipital lobes. d-up to 60% of patients have anti-neuronal antibodies in the serum and CSF. e-the paraneopastic syndrome can be static. Subchapter D: Q1- Spontaneous subarachnoid hemorrhage (SAH), what is the wrong statement? a-usually caused by a ruptured Berry aneurysm or arterio-venous malformation(AVM). b-its annual incidence is 6 per 100 000 populations/ year. c-ruptured Berry's aneurysm is mostly seen during the 5 th and 6 th decades of life. d-hypertension has not been conclusively demonstrated to predispose to the formation of the aneurysm. e-AVMs are very common cause of it world wide. Q2: Spontaneous subarachnoid hemorrhage (SAH), what is the wrong statement? a-Berry's aneurysm although is said to be congenital, it results from developmental weakness in the arterial wall. b-Berry's aneurysm is multiple in 90% of cases. [...]... xanthochromic after 1-2 hours d-the white cell count may be high e-the glucose level is normal initially Q8: Investigation in spontaneous subarachnoid hemorrhage (SAH), what is the wrong statement? a-the ECG may reveal a host of abnormalities b-once the diagnosis is made, a cerebral 4 vessel angiography should be done c-a 4- vessel angiography is preferred for those patients with a deep coma d-a 4 vessel angiogram... pressure b-dipolpia may be seen c- it is associated with many disorders d- the absence of headache is against the diagnosis e-the majority of patients are young Q 17: Pseudotumor cerebri, which is the wrong statement? a-diffuse headache is almost always the presenting symptom b-diplopia and blurred vision occur in 65% of cases c-visual acuity is normal in up to 50 of cases at the time presentation d-episodes... e-fortunately, visual loss is not seen in the idiopathic variety Q18: Pseudotumor cerebri, which is the wrong statement? a-the course is generally self-limiting over several months b-an intracranial mass lesion should always be excluded c-brain MRI typically reveals enlarged ventricles d-a part from an elevated opening pressure, all other CSF parameters should be normal in the idiopathic variety e-the... necessary Q15: Post-coital headache, which is the wrong statement? a-more common in males b-it is dull and bilateral and usually seen at the time of sexual excitement c-any patient with severe type of headache should be evaluated adequately for SAH d-it is a self limiting one e-may be due to marked fall in the systemic blood pressure Q16: Pseudotumor cerebri, which is the wrong statement? a-characterized... stem AVMs c-the sensitivity of the brain CT scan rises gradually day by day after the ictus d-brain MRI is not preferred because the patient may be irritable e-brain MRI sensitivity increases day by day after the ictus Q7: Spontaneous subarachnoid hemorrhage (SAH), CSF findings, what is the wrong statement? a-the opening pressure is usually very high b-the CSF is usually grossly bloody c-the supernatant... the hemorrhage e-of survivors, only 5% will be left with permanent brain injury Q 14: Post lumbar puncture (LP) headache , which is the wrong statement? a-characterized by marked increase in headache in the upright position b-the pain is typically occipital c-it is due to persistent spinal subarachnoid leak d-it can prevented or reduced by using small gauge needle for the puncture e-even in resistant... Q19: Pseudotumor cerebri, which is the wrong statement? a-in mild cases, acetazolamide with or without a diruretic would suffice b-in severe cases , high dose prednisolone is given c-in refractory cases, repeated lumbar punctures might be used d-in refractory cases, lumboperitoneal shunt may be a vision-saving procedure e-in refractory cades, trans-orbital optic nerve sheath fenestration should be done... wrong statement? a-apart from "triggering zones", the neurological examination should be totally normal b-MRI brain stem should be normal c-vertebrobasilar conventional angiography is always abnormal d-carbamazepin is the first line treatment e-posterior fossa microvascular decompressive surgery is used in drug resistant cases Q22: Glossopharyngeal neuralgia, which is the wrong statement? a-it is less common... which is the wrong statement? a-a lost blinking reflex in the right eye is against the diagnosis b-there may be evidence of corneal ulceration c-the forehead may contain small scars d-diminished pinprick sensation in the forehead skin may very subtle e-the patient is having visual loss in the right eye Q25: treatment Post-herpetic neuralgia, which is the wrong statement? a-no medication can prevent the... bleeding episode c-the systemic arterial blood pressure frequently drop precipitously as a result of hemorrhage d-the body temperature may reach 39 degree C during the first 2 weeks e-signs of meningeal irritation are very common Q6: Spontaneous subarachnoid hemorrhage (SAH), what is the wrong statement? a-non-contrast CT scan of the brain is the most sensitive initial investigation b-brain MRI may be . dementia. Q 34: Causes of proximal symmetrical myopathy, all of the followings are true, except: 1- Hypothyroidism. 2- Chronic alcoholism. 3- Cushing‘s disease. 4- Osteomalacia. 5- Diabetes. except: 1- Usually presents between the ages of 3-5 years. 2- There may be enlargement of the calves. 3- The CPK is high even from birth. 4- The commonest cause of death is cardiac problems. 5-. basophilic stippling- lead poisoning. 2- Psychosis and abdominal pain- acute intermittent porphyria. 3- Prominent postural hypotension and nephrotic syndrome- primary AL amyloidosis. 4- Hoarse voice–hyperthyroidism.