Neurology 4 mrcp answers book - part 9 doc

Answer: e a-true, with or without pre-existent hypertension. b-true, lower levels may suffice to produce the picture in previously normo-tensive people. c-true, and thus renal function should always be investigated. d-true, may present in stroke like pattern. e-false, it develops over a period of several hours to days. NB: pathophysiologically; there is diffuse cerebral vasospasm, impairment of cerebral autoregulation mechanisms of blood flow and increased blood coagulability. The net result is diffuse microinfarcts and petechial hemorrhages that are mainly seen in the brain stem, and to a lesser extent in the subcortical grey and white matter regions. Q52: Answer: e a-true, the most helpful and specific sign. b-true, with or without papilloedema. c-true, and elevated protein might also be seen. d-true, indicating areas of brain edema and these changes are reversible upon successful drug therapy. e-false, renal failure appears to increase the risk of developing hypertensive encephalopathy , thus blood urea and electrolytes should be estimated in all cases. NB: hypertensive encephalopathy is a diagnosis of exclusion. Q53: Answer: d a-true, without producing hypotension. b-true, and thus the infusions of antihypertensives should be carefully monitored to produce these targets. c-true, indicating over treatment and hypotension. d-false, it can given either by intravenous infusions or by repeated boluses. e-true, but prompt treatment usually produces FULL clinical recovery. Q54: Answer: e a-true, commonly seen between the age of 10 to 40 years. b-true ,50% in average. c-true, and also thrombocytopenia. d-true, causing small microinfacrts and discrete hemorrhages. e-false, true cerebral vasculits is very RARE. Q55: Answer: e a-true, the cognitive dysfunction includes acute confusional state, schizophreniform psychosis, depression and mania. b-true, but may be focal as well. c-true, also , diplopia, ptosis, hemiparesis, paraparesis and chorea all are less common findings. d-true, although anti ribosomal P protein is supposed to be associated with lupus psychosis, but still controversial issue. e-false, the EEG is usually diffusely slowed or there are focal abnormalities. Q56: Answer: d a-true, but in practice, cerebral lupus is by far much more common. b-true, also, infections, severe anemia, lupus endocarditis , metabolic and electrolyte disturbances. c-true, and if the patient is not receiving steroids, steroids should started at doses between 60-80 mg/dl. d-false, it has NOT shown to adversely affect the overall prognosis. e-true. Q57: Answer: d a-true, after ingestion of the larvae of the pork tapeworm. b-true, obstruction to the CSF pathways by intraventricular cysts, or inflammation causing basilar meningitis. c-true, also myelopathy and vague personality changes. d-false, typically shows lymphocytic pleocytosis with many esosinophils. The opening pressure might be high due cerebral mass lesions or very low in cases of spinal subsrachnoid block. e-true, also may show intracerebral calcification or ventricular enlargement. Q58: Answer: e a-true, however , patients with seizures and either meningitis or one or more noncalcified cysts should be treated. Intraventicular, subarachnoid and racemose cysts respond very poorly to treatment. b-true, as these can produce obstructive hydrocephalus. c-true, by thus removing a mass effect. d-true, might be the only option. e-false, calcified cysts DO NOT require treatment. Q59: Answer: c a-true, thus prophylaxis is very important. b-true, and causes occlusion of small cerebral blood vessels. c-false, it usually produces a global confusional state and seizures. Focal signs are RARE. d-true, with raised protein and mononuclear pleocytosis. e-true, 20-50% and may reach 80%in cases complicated by coma and seizures. Q60: Answer: e a-true, also there may cerebral infarction related to cerebral vaculitis and vernticular enlargement due to communicating hydrocephalus. b-true, might be also seen with actinomycosis and aspirgillus infections. c-true, may also resemble brain abscesses and neurosyphilis. d-true, like systemic cancer, diabetes, HIV , immune suppression, organ transplantation…etc. e-false, intravenous amphotericin B which should be used for 3 months. Unfortunately the treatment is long and expensive. End…of Neurology Chapter…. Chapter XII / Infectious diseases Answers Q1: Answer: 4 1- genralized lymphadenopathy may be seen. 2- but unfortunately needs long time in special culture media with special. environment. Also it is hazardous to the lab workers, so it is NOT used in almost all cases. 3- or a pseudotumor cerebri like picture. 4- false, very common. 5- true, especially in highly endemic areas, and 2 mercapto ethanol test is used in this situation. Q2: Answer: 5 1-unlike other salmonella species 2-also palpable spleen and rose spots are seen in the 2 nd week 3-but are highly suggestive when seen 4-about 90% positivity and then decreases there after 5-false, the main indication is in those who were exposed to antibiotics Q3: Answer: 5 1- should be done if malaria is suspected clinically. 2- and to count the parasitemia. 3- true, may cause hypoglycemia and cardiac toxicity and cinchonism. 4- and 3 rd trimester of pregnancy. 5- false, are of no benefit at all, actually it should be avoided. Q4: Answer: 5 1- true, like sewage workers or farmers. 2- true, urine culture becomes gradually positive in the second phase. 3- true, and may cause significant morbidity and mortality. 4- true. 5- there is blood neutrophil leukocytosis which is very important in differentiating leptospirosis from severe viral hepatitis infections. Q5: Answer: 4 1- other sources from skin abscess, conjunctivitis. 2- true, it is not a bacteremic infection; it is exotoxin mediated. 3- actually one of the diagnostic criteria. 4- false, up to 10%. 5- and usually necessitates the use of pressors. Q6: Answer: 5 1- usually through a bite of an infected animal. 2- the, the virus is present in the saliva, although it infects the CNS. 3- true, very few exceptions are documented world wide, yet they are left with severe neurological disability. 4- and so-called the dumb type found in 20 % of cases only; the other 80% is called the furious type with many characteristic phobias. 5- false, highly variable. Q7: Answer: 5 1- RNA one. 2- true after an incubation period of 1-3 weeks. 3- true, and circulatory collapse. 4- considered to be high 5- false, Ribavirin can be used and may decrease the mortality rate if given with in the 1 st week. Q8: Answer: 4 1- from monkeys through mosquitoes. 2- 3-6 days. 3- leukopenia is seen. 4- true, but not a specific picture. 5- false, no specific treatment, only supportive. Q9: Answer: 3 Till now there is no vaccine!!! Q10: Answer: 4 1- The disease is mainly seen in farmers and vets. 2- but usually other features are seen also. 3- true, and its treatment is usually prolonged; may be for 1 year. 4- false, the drug of choice. 5- true, liver granulomas might be seen, but usually these are asymptomatic. Q11: Answer: 4 1- may be mite, flea, tick and louse born. 2- in the skin, brain, lung. 3- true. 4- false, no such a feature. 5- or chloramphenicole. Q12: Answer: 5 1- true, actually many patients are not able to recall it. 2- true….may disappear before being noticed by the patient. 3- may be bilateral. 4- Borrelia burgdoferi. 5- false, asymmetric large joint oligoarthritis. Q13: Answer: 3 1- but involves the palms and soles. 2- True, rarely severe. 3- False, FTA absorption and TPHA are much more sensitive and specific. 4- and condylomata lata are seen in the genital areas. 5- True. Q14: Answer: 5 In general it is milder and shorter illness when compared with S. typhi infection. Q15: Answer: 5 1- so-called cholera sicca, causing large fluid loss and sequestration in the bowel. 2- true, a common infecting source is usually there. 3- can be seen under the microscope (comma shaped). 4- true, it is not an invasive disease. 5- false, painless diarrhea! Q16: Answer: 2 1- lymphogranuloma venereum, Chlamydia trachomatis serovars L1, 2, 3. 2- primary, not secondary! 3- usually type 2 viruses. 4- chanchroids. 5- granuloma inguinale. Q17: Answer: 3 1- true, if seen in a female child always think of sexual abuse which his VERY RECENT. 2- true, but may be mild. 3- false, can be cured by single dose of antibiotics like oral 500 mg ciprofloxacin once only; but because Chlamydia infections may be co-associated, so we give tetracycline for 10 days; always CONTACT SEXUAL PARTNERS. 4-true, the usually source of SPREADING of infection to males. 5-true, do you think that this infection makes them stop sexual contact? Q18: Answer: 3 Erythromycin is useful in the treatment of Legionares disease but not in the prophylaxis; besides, there is no man to man transmission of infection. Q19: Answer: 5 1- like gp 160 and 45. 2- unlike the western population in which P carinii is much more common. 3- the progression can be slowed by AZT therapy. 4- self limiting in healthy persons. 5- false, usually asymptomatic, unlike the pulmonary one which portends a very aggressive course. Q20: Answer: 5 1- similar to mitochondrial myopathy. 2- and many NRTIs can cause liver dysfunction and lactic acidosis and pancreatitis. 3- of many types of lipodystrophy. 4- and some may cause severe allergic reaction that needs drug stoppage for good. 5- nail pigmentation is characteristically seen with zidovudine. Q21: Answers: 3 Low hypoxemia ratio portends a poor outcome. Other predictors of a poor outcome: delayed diagnosis, low CD4 positive count, and hypoalbuminemia. Q22: Answer 5: Also they have a greater risk of developing military and disseminated TB, and of developing a second episode of TB from exogenous infection as demonstrated by isolate typing. Q23: Answer: 1 Option 1 is the typical established picture which is seen in 80% of cases; later an ARDS like picture will be seen. Atypical appearances are seen in up to 20% of cases; in addition to above, a nodular appearance is also seen. Q24: Answer: 4 1- prior to HAART, almost 25% of HIV patients with a CD4 positive count of less than 100/mm3 developed this grave complication. 2- and some may be totally asymptomatic and discovered by fundoscopic examination. 3- and from toxoplasma retinitis, progressive outer retinal necrosis syndrome, syphilis, and Pneumocystis. 4- No recovery of vision occurs in the affected areas and there is always a risk of retinal detachment because of retinal necrosis. 5- but is the most sight threatening. Q25: Answer: 5 1- it is a highly contagious zoonotic protozoal enteric pathogen. 2- and usually severe and persistent large volume painful water diarrhea. 3- and rarely can cause acalculous cholecystitis, sclerosing cholangitis, pneuomonitis. 4- or by using a modified acid fast satin on stool specimens in 90% of cases. 5- may respond to paramomycin and azithromycin. Q26: Answer: 4 1- and acquisition is probably through respiratory of GIT tract where colonization occurs and precedes the disseminated disease in 2/3 rds of cases. 2- but the reticulo-endothelial system bears the major burden of the infection. 3- and CT scans usually reveal an enlarged intra abdominal and mediastinal lymph nodes. 4- false, together with lymphadenopathy are commonly seen clinically. 5- or positive cultures of a liver biopsy or a bone marrow aspirates. Q27: Answer: 2 1- the highest count produced of all helmintic infestations. 2- the microfilariae survive for 2-3 years, and the adult worms for 10-15 years in general. 3- producing lymphatic filariasis. 4- transmitted by the day biting fly Chrysops. 5- the River Blindness, transmitted by a Simulium fly. Q28: Answer: 5 Ascarisis can cause eosinophlia. Other tropical infections not associated with eosinophilia: Leprosy, TB, Tapeworms, Typhoid fever and brucellosis, ameabiasis and ARBO viral infections. Q29: Answer: 4 Other causes: Hydatid disease, liver flukes, filariasis, and hook worms. Q30: Answer: e Cysticercosis does not produce a malabsorption state. Q31: Answer: 4 Oriental sore is caused by Leishmania tropica. Other options are true. Please review textbooks for furthere details of this topic. Q32: Answer: 5 Infections during the 1 st month of solid organ transplantation generally are not due to immune suppression; they are the infections seen commonly in post- operative patients. Nocardia infections indicate a prominent immune suppression in those patients and are seen between 2-6 months following solid organ transplantation. Q33: Answer: 5 Staph aureus infections are characteristically seen during the 1 st 4 weeks post transplantation in the form of skin wound infection, catheter related infection, and chest infection. During the 2 nd to 6 th months following solid organ transplantation the infections are of those seen in immune com[promised patients: in addition to the above; EBV, varicella zoster, papova viruses (JC and BK), adenoviruses, toxoplasma, nocardia, and pneurmocystis carinii. Q34: Answer: 1 Fecal leukocytes indicate an invasive pathogen; cholera is not an invasive infection and hence no fecal leurkocytes are found on stool examination. All other options are true. Q35: Answer: 4 Chagoma is due to local replication of Trypanosoma cruzi at the site reduviid bug bite. Q36: Answer: 5 Having a cat at home does not confer an increased risk of skin candidiasis; other infections that might be seen: Pasteurellosis (usually a bite wound), Cat scratch disease, Tularemia, hook worms, and rabies. Q37: Answer: 4 A tricky question. Causes of an acute false positive RPR test: Pregnancy, recent immunization, febrile illnesses. Causes of chronic false positive RPR test: Chronic infections, autoimmune diseases, and iv drug addicts. In false positive testing, the tire is usually below 1:8. Q38: Answer: 5 The first 3 options are the cause of a false positive monosopt test; option 4 is the cause of a truly positive test; option 5 has nothing to do with monospot tests. Q39: Answer: 4 Guillain Barre syndrome is a cause of acute inflammatory demyelinating polyradiculopathy; so no increase in muscle tone is noted. Causes of lock jaw apart from tetanus: 1- Any inflammatory lesion in the mouth, pharynx, cheeks, or external auditory canal (like Ludwig's angina, peritonsillar abscess, tooth abscess). 2- Malignancies; sarcoma of the jaw (squamous cell carcinoma of the oral cavity). 3- Conversion disorders; hysterical tetanus. 4- Mechanical problems; jaw dislocation, jaw ankylosis. 5- Phenothiazines; part of dystonic reactions. 6- Strychnine poisoning; a late sign. 7- Encephalitides. Q40: Answer: 1 The grove sign is due to adenopthy above and below the inguinal ligament; said to pathognomonic to LGV in the appropriate clinical setting. [...]... defect Q4: Answer: 5 1-considered to be a primary not a secondary phenomenon 2-also, gold and penicillamine 3-and nephritic syndrome 4- also CLL and MM 5-false …associated with hypergammmaglobulinemia mainly of IgG type Q5: Answer: 5 1-true… and the spleen also may be enlarged in 30% of cases 2-and IgM may be normal or low or even raised 3-true … The T cells are usually functionally immature 4- and there... is the IgM 2-true………very higher than asthma useful clue when suspecting ABPA complicating asthma 3-IgM not IgG 4- true.it is not that rare … 5-true Many don’t know that Q3: Answer 5 1-or IgM IgA activates the alternative pathway 2-and hence family tree is important in the male relatives 3-true…… including recurrent meningitis 4- true….? may be due to inability to remove immune complexes 5-fasle 10% only... penicillamine Q9: Answer: 5 1-Depending on certain chemokine receptors and associated ligands 2-hence the hypergammaglobinemia 3-true…usually under estimated 4- true…… many complicated mechanisms 5-false ……….it is CD4 positive and infected early in the course … Hence the name M (macrophage) strains of the virus Q10: Answer 5 1-unlike the widely distributed class I 2-true…like the blood ABO antigen 3-true…short... Immunology Answers Q1: Answer 4 1-true……hence IgA deficiency may cause chronic or repeated sinu-plumonary and GIT infections 2-agglutinating one 3-hence the passive neonatal immunity and false positive neonatal screening for many infections (actually from the mother!!) 4- type I ……….a famous thing 5-yes….actually its function is still not that 100% … Has a very low serum level Q2: Answer 3 1-also certain... prognosis 2-true …….the presence of poor job records indicates poor prognosis 3-true…… also absence of family history and catatonic variety has good prognosis 4- true Schizoid one portends a bad prognosis 5-false…….confers a bad prognosis Q5: Answer 4 1-the patient feels worthless, helpless and hopeless 2-others gain weight 3-anhedonia 4- false …… some patients it is very prominent so called agitated depression... trifluperazine 4- true….especially haloperidol (Haldol) 5-false, some tricyclic antidepressants may be used here Q7: Answer 5 1-true….many new anti depressants may have varieties of mechanisms 2-true…… and also old men may have occult prostatism or glaucoma, so be careful 3-very important in old people as it may increase the risk of fall 4- true….so be patient 5-false … In these cases, electro-convulsive... Answer: 4 1-true……check their relatives for CVID!! 2-because of the resulting gut hypomotility may be an additional risk factor for bacterial overgrowth 3-true……as blood or blood product transfusion may cause severe anaphylactic reactions 4- fasle….around 3 -4 % … And may cause false negative IgA anti-endomycium antibodies testing …….hence we check both IgA and IgG there to overcome this problem 5-true….due... in the books !! Q2: Answer 3 1-and TSH, FSH and LH are reduced 2-cold extremities, lanugos hair ………remember in anorexia nervosa there is starvation and stress 3-false ……….against the diagnosis 4- and loss of libido also The loss of weight must be more than 25% of the original weight or the current weight is blow 25% of the normal for age and sex 5-true……bulimia usually starts later Q3: Answer 4 1-flase... 5-fasle …increased risk of selective IgA deficiency Q6: Answer 5 Chronic active hepatitis is associated with hypergammaglobinemia is not a complication of HYPOgammaglobinemia Q7: Answer: 5 1-hence no defective cell medicated immunity 2-true … due to defective maturation in the bone marrow 3-true, usually below 50 mg / dl 4- usually with repeated chest infection 5-fasle…fortunately rare Q8: Answer: 4. .. they maintain weight 2-typically post pubertal but later than anorexia nervosa peak 3-false……rarely required 4- true, to be followed by self induced vomiting, diuretic or laxative abuse……or the patient may enter a phase of prolonged dieting after these recurrent binge eating episodes 5-false….suggests anorexia nervosa Q4: Answer: 5 1- chronic insidious one has a bad prognosis 2-true …….the presence . Q8: Answer: 4 1- from monkeys through mosquitoes. 2- 3-6 days. 3- leukopenia is seen. 4- true, but not a specific picture. 5- false, no specific treatment, only supportive. Q9: Answer:. prognosis 4- true Schizoid one portends a bad prognosis 5-false…….confers a bad prognosis Q5: Answer 4 1-the patient feels worthless, helpless and hopeless 2-others gain weight 3-anhedonia 4- false. characteristic phobias. 5- false, highly variable. Q7: Answer: 5 1- RNA one. 2- true after an incubation period of 1-3 weeks. 3- true, and circulatory collapse. 4- considered to be high 5- false, Ribavirin