Neurology 4 mrcp questions book - part 8 pdf

b-the pain can be relieved by amytryptiline. c-topical xylocain gel may be useful. d-topical capsaicin should be avoided. e-intractable cases ca nbe treated by intra-thecal methyl prednisolone injection. Q26: Atypical facial pain syndrome, what is the wrong statement? a-it is a constant boring mainly unilateral lower facial pain. b-unlike trigeminal neuralgia, it is not confined to the trigeminal nerve distribution. c-must be differentiated from pain syndromes due to nasopharyngeal carcinoma. d-usually responds to well to non steroidal non inflammatory drugs. e-phenytoin is a second line therapeutic option. Q27: the headache of Migraine, which is the wrong statement? a-usually unilateral. b-frequently pulsatile. c-often associated with nausea and vomiting. d-accompanied by visual auras in 90% of cases. e-attacks woman more commonly than men. Q28: Genetics of migraine, which is the wrong statement? a-the aggregation of migraine within families has long been recognized. b-concordance rate in monozygotic twins is 30-50%. c-familial hemiplegic migraine is the only subtype that has a straightforward autosomal dominant mode of inheritance. d-possibly there are multiple migraine genes. e-environmental factors have no role in the genesis of migraine. Q29: Migraine with aura, which is the wrong statement? a-the commonest type of aura is a visual one. b-the majority of patients would suffer a single attack / week. c-remissions are common during the 2 nd and 3 rd trimesters of pregnancy. d-in elderlies the prodromal symptoms may occur without headache. e-the headache should be unilateral. Subchapter E: Q1: A 30 year old man presents to the A/E department with an acute confusional state. He is hypothermic .Which one of the followings might be a cause of this presentation: a-sympathomimetics intoxication b-anticholinergic intoxication c-alcohol withdrawal d-pyogenic meningitis e-sedative drug intoxication Q2: A 45 year old man presents to the A/E department with disturbed level of consciousness and a marked hypertension. All but one of the followings can be a cause: a-anticholinergic intoxication b-subarachnoid hemorrhage c-ethanol withdrawal d-sympathomimetic intoxication e-bleeding peptic ulcer Q3: A 24 year old woman presents to the A/E department with an agitated confusional state. Examination revealed bilaterally dilated pupils. All but one of the followings can be a cause of such a presentation: a-anticholinergic intoxication b-sympathomimetic intoxication c-opioid intoxication d-ethanol withdrawal e-head trauma Q4: A 43 year old woman presents to the A/E department with impaired level of consciousness. Examination revealed prominent hypoventilation. All but one of the followings can be the cause of her presentation: a-pulmonary encephalopathy b-hepatic encephalopathy c-opioid intoxication d-ethanol intoxication e-sedative drug intoxication Q5: A 57 year old man presents to the A/E department with an acute confusional state. Examination revealed left sided hemiparesis. All but one of the followings can be the cause of his presentation: a-cerebral ischemic infarction b-hypoglycemia c-hyperglycemia d-subdural hematoma e-Wernick's encephalopathy Q6: A 32 year old man presents with an impaired level of consciousness. He has a history of epilepsy . Which one is the wrong statement regarding the importance of his past history of epilepsy: a-He might have a complex partial status epilepticus presenting as a confused dazed state. b-He might sustain a head injury following a seizure. c-He might have a prolonged post-ictal phase d-He might be intoxicated with one of his antiepileptics e-His past history of epilepsy is not important Q7: A 65 year old man presents with disturbed level of consciousness. which one is the wrong statement : a-history of diabetes mellitus may indicate a hyperosmolar non-ketotic state or an insuline induced hypoglycemia b-a past history of head injury is important as this may indicate a post-traumatic amnestic state or chronic subdural hematoma c-a prominent odor of alcohol might be incidental and is better to be neglected. d-past history of depression may indicate a recent suicidal attempt and hence drug poisoning should be suspected . e-history of homosexuality is important as it may indicate HIV infection with a CNS complication. Q8: Regarding history taking and examination in a demented patient, which one is the wrong statement? a-past history of homosexuality is not important b-past history of hypertension is useful c-examination of his pulse can provide many clues d-his body temperature can suggest an etiology for his dementia e-papillodema might be seen Q9: Ethanol intoxication, which one is the wrong statement: a-ethanol intoxication produces nystagmus, dysarthria ,limb and gait ataxia b-in non-chronic alcoholics, the clinical manifestations decline over hours despite a stable blood ethanol level. c-plasma osmolality is useful in the assessment and should be normal in acute intoxication d-should be differentiated from sedative-hypnotic drugs intoxication e-might cause life threatening hypoglycemia Q10: Ethanol withdrawal subtype tremulousness and hallucination, which one is the wrong statement: a-is considered to be a benign self-limiting condition b-usually seen within 2 days after cessation of drinking c-there is agitation, anorexia, hypertension ,insomnia and tachycardia d-prominent confusion dominates the clinical picture e-can be treated by chlodiazepoxide or diazepam Q11: Ethanol withdrawal fits (Rum Fits), which one is the wrong statement: a-usually seen within 2 weeks after the beginning of abstinence. b-more than 90% of patients will have between 1 to 6 seizures. c-anticonvulsant treatment is usually not required . d-focal seizures should be taken seriously and may suggest another diagnosis or a co- existent pathology. e-the patient should be closely observed for any subsequent or concomitant complications of alcohol. Q12: Ethanol withdrawal subtype delirium tremens, which one is the wrong statement: a-It the most serious of all ethanol withdrawal syndromes. b-characterized by confusion, agitation, fever and hallucination. c-fortunately the mortality rate is low around 1%. d-should be treated with diazepam 10-20 mg intravenously and repeated every 5 mintues as needed until the patient is calm. e-concomitant treatment with beta blockers is also advisable . Q13: Sedative drug intoxication, which one is the wrong statement: a-can present as a confusional state or coma . b-the pupils are usually reactive and prominent papillary abnormalities should prompt a search for another pathology. c-nystagmus, gaze paresis , decerebrate or decorticate posturing might be seen . d-the mortality rate is unfortunately very high and is due to the CNS depressant effect of these medications. e-forced alkaline diuresis is ineffective for short acting barbiturates. Q14: Sedative drug withdrawal, which one is the wrong statement: a-the frequency and severity of these withdrawal syndromes depend on the duration of drug intake, total daily does and the half life of the medication. b-the overall clinical picture can exactly resemble ethanol withdrawal syndromes and is also self limiting. c-the diagnosis can be confirmed by Phenobarbital challenge test. d-like ethanol withdrawal seizures, seizures here should not be treated with anticonvulsants. e-a delirium tremens like syndrome may be seen 3-8 days after abstinence. Q15: Opioid overdoses, which one is the wrong statement: a-can present as an iatrogenic confusional state or coma in hospitalized patients . b-the cardinal features are pinpoint pupils and respiratory depression. c-can simply be confirmed at the bed side by giving naloxone to the patient. d-the mortality rate is very high. e-because most opioids are long acting, nalaxone should be given repeatedly . Q16: Antichlinergics intoxication, which one is the wrong statement: a-can be seen with antipsychotics overdoses. b-produces a characteristic picture of agitated delirium and fever, dry skin, fixed dilated pupils, blurring of vision and hallucinations. c-can be confirmed by toxicology screen of blood and urine. d-the symptoms are usually progressive with a high mortality rate. e-can be treated with physostigmine. Q17: Sympathomimetic intoxication, which one is the wrong statement: a-can produce hyperactivity , hallucinations and schizophreniform paranoid psychosis b-cardiac dysrrhytmias are the main cause of serious morbidity. c-amphetamine and cocaine can produce thrombotic or hemorrhagic strokes. d-Beta blockers are very useful in cases complicated by severe hypertension. e-Haloperidol can be very useful to offset the central dopaminergic effects . Q18: LSD (lysergic acid diethylamide) intoxication, which one is the wrong statement: a-can produce nystagmus, ataxia , hypertonia and hyperreflexia. b-visual and somatosensory illusions and hallucinations are the hallmark of this syndrome. c-seizures are very common and should be treated aggressively. d-there is dilated pupils and hyperthermia e-treatment usually involves verbal calming and reassurance. Q19: PCP (phenelcyclidine) intoxication, which one is the wrong statement: a-considered to be a medical emergency with many fearful and aggressive complications. b-the patient can be drowsy or extremely agitated with amnesia, hallucinations, and violent behavior. c-phenothiazines should given in the treatment of psychotic features. d-in general , signs and symptoms resolve with 24 hours. e-might be complicated by severe hypertension, status epilepticus , malignant hyperthermia, coma and death. Q20: Drug -induced confusional state might be caused by all of the followings except one : a-when used in larger than customary doses. b-many medications can cause prominent confusion in elderly people even when given in small recommended doses. c-especially seen when the metabolism of the medication is impaired by organ failure. d-those with pre-existent cognitive impairment are more susceptible to drug-induced confusional states. e-poly-pharmacy protects against the development of drug-induced confusional states. Q21: A 65 year old woman presents with few months history of aches and pains , constipation, cold intolerance. The diagnosis is hypothyroidism. Regarding the neurological complication of hypothyroidism, which one is the wrong statement? a-can produce a confusional state or coma . b-bilateral ptosis is common and sensorineural deafness might be detected. c-cognitive dysfunction is usually manifested by a flat affect and a psychomotor retardation. d-the most characteristic neurological finding is generalized tonic clonic seizures. e-CSF protein is typically elevated. Q22: A 33 year old woman underwent surgical removal of her thyroid gland as a treatment option of Grave's disease. After the operation she developed an acute confusional state and diagnosed as having thyrotoxic crisis. Regarding this complication, which one is the wrong statement? a-young patients usually develop an acute confusional state with agitated delirium accompanied by hallucination and frank psychosis. b-old people tends to be apathetic and depressed upon having this complication. c-should be differentiated from sympathomimetic drug intoxication. d-seizures may occur and especially seen in those with pre-existent epilepsy. e-clonus and extensor planter responses are a very common neurological finding. Q23: A 21 year old man with type I diabetes presents to the A/E department with repeated myoclonus and reactive dilated pupils. His random blood sugar was 20 mg' dl. Regarding neurological manifestations of hypoglycemia, which one is the wrong statement: a-the warning somatic hyper-adrenergic features might be absent, thus the patient may present with a progressive coma. b-small pupils , depressed deep tendon reflexes and hypotonia indicate an advanced stage which is usually irreversible. c-there is no strict correlation between the blood glucose levels and the severity of the neurological dysfunction. d-the clinical picture may exactly resemble rostral-caudal herniation syndromes due to supra-tentorial mass lesion. e-the patient is always seen with an agitated delirium state. Q24: A 68 year old man presents to the A/E department with few days of progressive lethargy, dehydration and seizures. He has no history of diabetes. His random blood sugar is 650 mg/ dl. Regarding hyperglycemic encephalopathy in hyperosmolar non-ketotic hyperglycemia, which is the wrong statement? a-the severity of hyperosmolarity correlates well with depression of the level consciousness. b-focal neurological signs are commonly seen. c-the mortality rate is fortunately low. d-profound metabolic acidosis and ketosis is absent. e-coma at presentation is commonly found . Q25: Neurological manifestation of electrolytes disorders, which is the wrong statement? a-in acute hyponatremia , the presentation may be with acute confusional state, focal or generalized seizures, papilledema, extensor planters and asterixis. b-aggressive and rapid correction of hyponatremia can result in sudden flaccid quadriparesis, upgoing planters , dysphagia and dysarthria. c-in hypercalcemia , a generalized myopathic weakness which characteristically spares the bulbar muscles can be seen. d-focal or generalized seizures are very commonly seen. e-prominent neurological manifestations in hypercalcemia are invariably present when the serum calcium is above 17 mg/dl (8.5 meq/L ). Q26: A 30 year old woman presents with perioral and acral numbness. She underwent subtotal thyroidectomy 5 days ago. Her serum calcium is 6.5 mg/dl. Regarding neurological manifestations of hypocalcemia, which is the wrong statement? a-they result from neuronal hyper-excitability due to lowered depolarization threshold in muscles and nerves. b-seizures and laryngospasm are commonly seen and can be life-threatening. c-prolonged hypocalcemia can cause cataract and papilloedema. d-carpo-pedal spasms can occur spontaneously. e-the presence of chorea is strong evidence against the diagnosis. Q27: A 50 year old heavy alcoholic man, presents to the A/E department with disturbed level of consciousness and abnormal gait. Eye examination revealed bilateral lateral rectus weakness. The diagnosis was Wernicke's encephalopathy. Regarding this diagnosis, which one is the wrong statement? a-pathologically, there is neuronal loss, demyelination and gliosis that are mainly seen in the preiventricular grey matter regions. b-nystagmus may be horizontal or a combined horizontal and vertical one. c-dysarthria and limb ataxia are very prominent. d-most patients have peripheral neuropathy with absent ankle jerks. e-the confusional state may progress to coma only in few patients. Q28: A 40 year old heavy alcoholic man, presents to the A/E department with disturbed level of consciousness and abnormal gait. Eye examination revealed many findings. The diagnosis was Wernicke's encephalopathy. Regarding ocular manifestations of Wernicke's encephalopathy, which one is the wrong finding? a-internuclear ophthalmoplegia . b-bilateral ptosis and retinal hemorrhages. c-conjugate gaze palsy or weakness. d-prominently dilated fixed pupils. e-impairment of vestibular focusing mechanisms. Q29: A 35 year old heavy alcoholic man, presents to the A/E department with disturbed level of consciousness and abnormal gait. Eye examination revealed bilateral external rectus weakness and horizontal nystagmus. The diagnosis was Wernicke's encephalopathy. Regarding the prognosis of Wernicke's encephalopathy following treatment, which one is the wrong statement? a-ocular abnormalities usually begin to improve within 1 day. b-ataxia usually begins to improve within 1 week. c-up to 60% of patients are usually left with horizontal nystagmus and mild gait ataxia. d-the major long term complication is the development of Korsaoff's syndrome. e-the acute cofusional state is usually partially reversible after receiving thiamine infusions. Q30: A 65 year old woman presents with few months history of lethargy, progressive pallor and vague personality changes. She is then diagnosed as having vitamin B12 deficiency. Regarding neurological complications of vitamin B12 deficiency, what is the wrong statement? a-when cerebral involvement predominates, the major clinical feature is mood changes, confusional state or psychosis. b-a tight band-like sensation around the trunk can be seen. c-spastic paraparesis, sensory ataxia and loss of ankle jerks inmdicate a prominent involvement of the spinal cord. d-the CSF analysis is normal although a mild increase in protein is sometimes seen. e-the greatest difficulty in differential diagnosis arises when cerebral symptoms occur without anemia or spinal cord disease. Q31: A 47 year old man presents to the A/E department with 5 days history of disturbed consciousness. His girlfriend gave a history of hematemesis . There is a heavy alcohol intake since 20 years. He is jaundiced with marked ascites. The diagnosis is hepatic encephalopathy following upper gastrointestinal bleeding in alcoholic cirrhosis. Regarding the neurological manifestations of this condition, which is the wrong statement? a-the cognitive disturbance includes a somnolence state or an agitated delirium state. b-the most helpful neurological sign is asterixis. c- Focal or generalized seizures might be seen. d-the most helpful CSF finding is an elevated glutamine level. e-the EEG should be normal. Q32: A 22 year old woman developed acute renal failure following heavy vaginal bleeding at childbirth. She has an agitated delirium state due to uraemic encephalopathy. Regarding the neurological manifestations of this condition, which is the wrong statement? a-the severity of measured biochemical abnormalities correlates poorly with symptoms. b-meningeal signs are sometimes seen. c-the CSF can show an elevated opening pressure, mild lymphocytic or polymorphonuclear pleocytosis,and increased protein. d-decorticate or decerebrate posturing are never seen. e-while dialysis reverses the encephalopathy, clinical improvement still often lags behind normalization of blood urea nitrogen and creatinine. Q33: A 23 year old man referred to you as having severe headache, nausea, muscle cramps, and seizures following a dialysis session for an acute renal failure following a car accident and heavy bleeding. You suggest the development of dialysis disequlibrium. Regarding the neurological manifestations of this condition, which is the wrong statement? a-dialysis disequilibrium is most common with a patient's first hemodialysis. b-results from rapid removal of urea and other molecules from blood leading to relative hypo-osmolality of extra-cellular fluid with a shift of water into the brain. c-the EEG may deteriorate during or after dialysis. d-myoclonus, asterixis, coma and generalized seizures are very common. e-Specific treatment is generally not required unless seizures occur. Q34: A 18 year boy with Duchenne's muscular dystrophy presents with few weeks history of progressive somnolence and seizures. His respiration is feeble. You suggest pulmonary encephalopathy complicating his muscle illness. Which is the wrong statement regarding pulmonary encephalopathy? a-neurological examination may show altered mentation, papilloedema myoclonus and asterixis. b-focal neurological signs are characteristically absent. c-tendon reflexes are usually decreased. d-intravenous sodium bicarbonate is very helpful in the treatment. e-when untreated, may lead to deep coma and death. Q35: Tuberculous meningitis, which is the wrong statement? a-the principal neuropathological finding is the presence of a thick greenish yellowish basal meningeal exudates containing mainly mononuclear cells. b-tubercles might be seen on the meninges. c-the ventricles may be enlarged due to hydrocephalus. d-arteritis can result in cerebral infarction. e-basal inflammation and fibrosis rarely if ever compresses the cranial nerves. Q36: Tuberculous meningitis, which is the wrong statement? a-a history of contact with known cases of tuberculosis is usually absent. b-fever, confusion and signs of meningeal irritation are commonly found on clinical examination. c-prominent ocular palsies and papilloedema can be seen. d-the presence of seizures is against the diagnosis. e-might be complicated by hydrocephalus, stroke, brain edema and spinal subarachnoid block. Q37: CSF analysis in tuberculous meningitis, which is the wrong statement? a-the CSF is usually under pressure and is clear and colorless. b-lymphocytic or mononuclear pleocytosis is seen but polymorphonuclear pleocytosis might be seen early . c-the protein is usually above 100mg/dl but rarely reaches higher levels. d-a decreased chloride level is no longer useful in the diagnosis. e-the glucose is decreased but rarely below 20mg/dl Q38: Pyogenic bacterial meningitides, which his the wrong statement ? a-neuro-pathologically, it is characterized by the presence of leptomeningeal and perivascular infiltration with polymorphonuclear leukocytes and an inflammatory exudates. b-the pathological changes are more marked over the cerebral convexities in streptococcus pneumoniae and hemophilus infections. c-bacterial invasion of the underlying brain is very common. d-brain edema, hydrocephalus and cerebral infarction may occur. e-the low levels of antibodies and complements in the subarachnoid space are inadequate to contain the infection. Q39: Q38: Pyogenic bacterial meningitides, which his the wrong statement ? a-at presentation , the majority of patients have had the symptoms for 1-7 days. b-signs of meningeal irritations are present in up to 80% of cases only. c-seizures and cranial nerve palsies may be seen at presentation. d-petechial rash is seen up to 90% of cases of H. infleunzae infections. e-the majority of patients presents with fever, confusional state, vomiting ,photophobia and neck stiffness. Q40: Q38: Pyogenic bacterial meningitides, which his the wrong statement ? a-peripheral blood counts may reveal polumorphonuclear leukocytosis or leucopenia. b-the causative organism can be cultured from the peripheral blood in 10% of cases only. c-a brain CT scan with contrast may show enhancement of the cerebral convexities , basal cisterns and ventricular epndyma. d-the EEG is usually diffusely slowed. e-X ray of the chest, sinuses or mastoid may indicate a primary site of infection. Q41: Q38: CSF analysis in pyogenic bacterial meningitides, which his the wrong statement? a-the opening pressure in elevated in 90% of cases only b-the CSF white cell count usually ranges between 1000-10000 cells/ml. c-the CSF glucose is lower than 40mg/ dl in about 80% of cases d-Gram stain of CSF identifies the causative organism in 10-20 of cases only. e-PCR has been used to diagnose N. meningitidis, H. influenzae and L. monocytogenes meningitis. Q42: In the treatment and prophylaxis of pyogenic meningitis, which is the wrong statement? a-the initial choice of antibiotic is empirical. b-the use of corticosteroids is still controversial. c-when using the right antimicrobial, the CSF should be sterile within 24 hours. d- house-hold contacts should be given rifampin 20 mg/ kg/ day , twice daily for 2 days in cases of H. influenzae meningitis. e-children should be routinely immunized against H.influenzae. Q43: The prognosis of pyogenic meningitis, which one is the wrong statement? a-Streptococcus pneumoiae infections per se portend a very bad prognosis with high mortality rates. b-N. meningitides infections can be complicated by an acute adrenal failure. c-presentation with stupor or coma portends a bad prognosis. d-the presence of seizures or focal neurological signs does not affect the prognosis. e-the prognosis in the extremes of age in general is poor. Q44: Syphilitic meningitis, which is the wrong statement? a-it is an acute or sub-acute process that is usually seen within 12 years of a primary syphilitic infection. b-it is clinically significant only in few patients. c-neurological examination may show a confusional state, neck stiffness, papilloedema, cranial nerve palsies. d-surprisingly fever is usually absent. e-should always be treated. Q45: Syphilitic meningitis, which is the wrong statement? a-CSF VDRL and serum FTA-tests are usually negative. b-CSF protein electrophoresis may reveal the presence of discrete oligoclonal bands of gamma globulins. c-the CSF protein is raised, the pleocytosis is mononuclear and the sugar is usually decreased. d-should be treated with high intravenous doses of penicillin G for 10 days. e-after treatment, the CSF should be examined at 6-monthly intervals until all findings are normal. Q46: Herpes simplex virus ( HSV )encephalitis, which is the wrong statement? a-it is the commonest sporadic fatal encephalitis. b-2/3rds of cases involve patients over 40 years of age. c-it is not clear whether HSV type I encephalitis in adults represents a primary infection or a reactivation of a latent infection. d-it usually involves the parieto-occipital junction. e-neruopathologically, it is an acute asymmetric hemorrhagic necrotizing process with lymphocyte and plasma cell infiltration. Q47: Herpes simplex virus ( HSV )encephalitis, which is the wrong statement? a-active herpes labialis is occasionally seen . b-HSV encephalitis is usually rapidly progressive. c-there might be headache , anosmia, aphasia and behavioral changes. d-focal or generalized seizures are never seen e-the commonest sequelae in survivors are memory and behavioral disturbances. [...]... always negative 3- Serum CPK is commonly raised 4- The mortality rate is 90% 5- Shock is usually resistant to fluid therapy Q6: Rabies, all of the followings are true, except: 1- Caused by a RNA rhabdoviurs infection 2- Transmitted through animal saliva 3- Once symptomatic, it is almost virtually fatal 4- May present as an ascending paralysis state 5- The incubation period is unfortunately very short... wrong statement? a-it is the commonest autoimmune cause of encephalopathy b-it is seen in 3 0-7 0% of SLE cases c-clinical features that best correlate with nervous system involvement are active muco-cutaneous or visceral vasculitis d-neuropathologically , there is finrinoid necrosis of small arterioles and capillaries e-florid vasculitis of cerebral blood vessels are very common Q55: Neuro-Lupus (neurological... statement? a-the disease affects the brain in 6 0-9 0% of cases b-the neurological manifestations may result from mass effect of intraparenchymal cysts c-clinical manifestations include headache, seizures, hydrocephalus, and subacute meningitis d-CSF usually shows polymorphonuclear pleocytosis e-CT scan may show contrast enhanced mass lesions with surrounding edema Q 58: Treatment of neuro-cysticercosis,... followings are true, except: 1- Human being is the only reservoir 2- Constipation is seen in the first week while diarrhea is seen in the second week 3- Rose spots are seen in a minority 4- Blood cultures have the highest yield in the first week 5- Bone marrow cultures are useless in those who were partially treated Q3: Malaria, all of the followings are true, except: 1- The thick blood film is mainly... important 2- The early phase is due to leptospiremia and hence the blood culture here has high positive results 3- Hemorrhagic manifestations are common 4- The second phase is an immune mediated one 5- There is peripheral blood lymphocytosis Q5: Toxic shock syndrome, all of the followings are true, except: 1- 2/3rds of cases are due to infected tampons 2- Blood cultures are almost always negative 3- Serum... statement? a-the objective is to decrease the mean blood pressure by no more than 2 0-2 5% within the first hour of treatment b-the objective is to not to decrease the diastolic blood pressure below 100 mmHg in the first hour c-the treatment should be stopped immediately if neurological function worsens d-oral labetalol is very useful e-untreated , it can result in stroke, coma and death Q 54: Neuro-Lupus... is the wrong statement? a- although malaria is the commonest parasitic infection world-wide, cerebral involvement is rare b- the plasmodia reaches the CNS in infected RBCs c- focal neurological signs are very common d- the CSF may show raised opening pressure and xanthochromia e- the mortality rate is unfortunately high Q60: fungal meningitis, which is the wrong statement? a- pathologically , there... XII / Infectious disease Q1: Brucellosis, all of the followings are true, except: 1- Splenomegally usually indicates a chronic brucellosis or a severe acute infection 2- The gold standard investigation is blood culture 3- Neuro-brucellosis may presents like multiple sclerosis 4- Spinal tenderness is highly uncommon 5- Usually it is clinically difficult to differentiate a new infection from a relapsing... SLE), which is the wrong statement? a-the commonest features are seizures and altered mental status b-seizures are usually generalized c-visual impairment from optic nerve involvement is uncommon d-No laboratory finding is diagnostic of CNS lupus e-the EEG is almost always normal Q56: Neuro-Lupus (neurological complications of SLE), which is the wrong statement? a-a common dilemma is to differentiate... used for a rapid diagnosis 2- The thin blood film is used to confirm the diagnosis and to sepeciate the organism 3- Severe infections should be treated with intravenous Quinin 4- Mefloquin is contraindicated in epilepsy and lactation 5- Steroids are very useful in treating cerebral malaria in falciparum infections Q4: Leptospirosis, all of the followings are true, except: 1- The occupation or the hobby . presentation: a-anticholinergic intoxication b-sympathomimetic intoxication c-opioid intoxication d-ethanol withdrawal e-head trauma Q4: A 43 year old woman presents to the A/E department with. cause: a-anticholinergic intoxication b-subarachnoid hemorrhage c-ethanol withdrawal d-sympathomimetic intoxication e-bleeding peptic ulcer Q3: A 24 year old woman presents to the A/E department. presentation: a-sympathomimetics intoxication b-anticholinergic intoxication c-alcohol withdrawal d-pyogenic meningitis e-sedative drug intoxication Q2: A 45 year old man presents to the A/E department