56-80 LT Quiz

Question 1

What treatment approach should be chosen for acute inflammatory demyelinating polyneuropathy?

Answer 1

Intravenous immunoglobulin or plasmapheresis

Question 2

Which pathogens most commonly cause bacterial meningitis in people aged 18-50?

Answer 2

Streptococcus pneumoniae, Neisseria meningitidis

Question 3

The strength of the patient’s legs in all muscle groups is 1-2 points. What exercises will
you use first to strengthen your muscles ?:

Answer 3

isometric

Question 4

Which of the following are neuropathic pain syndromes?

Answer 4

postherpetic neuralgia, painful diabetic neuropathy, trigeminal neuralgia

Question 5

Medications can be used for epilepsy treatment

Answer 5

Oxcarbazepine, levetiracetam, valproate

Question 6

55-year old male complains of bilateral leg weakness that makes him look at the ground and use a cane while walking. Also his sleep is disturbed because of a burning sensation in his feet. Examination reveals bilaterally absent Achilles reflexes and impairment of sensation of all modalities in the legs. What condition would you suspect?

Answer 6

Polyneuropathy

Question 7

62a)Signs and symptoms characteristic of meningitis caused by enterovirus:

Answer 7

Summer-autumn seasonality, possible route of transmission is air-borne and fecal-oral.

Question 8

62b)Signs and symptoms characteristic of tuberculous meningitis:

Answer 8

Subacute course, normal or subfebrile temperature, low glucose in CSF.

Question 9

62c)Signs and symptoms characteristic of early disseminated neuroborreliosis:

Answer 9

Subacute course, normal or subfebrile temperature, lymphocytic pleocytosis in CSF.

Question 10

62d)Signs and symptoms characteristic of tick-borne encephalitis:

Answer 10

Two-wave course of the disease, long recovery time, long-term sequelae in 1/3 of the patients.

Question 11

The auditory nerve neurinoma clinic starts with:

Answer 11

Ipsilateral non-pulsating murmur

Question 12

The slit in one of the patient’s eyes is narrower, the upper eyelid does not rise upwards, the pupil is wide, the eyes are directed outwards and downwards, limited movements inwards and upwards. What violation?

Answer 12

III cranial nerve

Question 13

Which of the neuromuscular diseases features the following course: constant progression, spasticity, development of amyotrophy and contractures, followed by dysarthria, dysphagia and respiratory failure?

Answer 13

ALS - Amyotrophic lateral sclerosis

Question 14

44 m. an old man living in a village, abusing alcohol. Infectious Diseases Clinic, he complained of headaches in the occipital area lasting about two weeks, with a fever of up to 37.7 ° C. sleepy, aggressive at intervals. Neck muscle rigidity (±), Kernig s. (-), scalp nerves – nothing significant., reflexes (+), pathological reflexes - . cytosis 132 x106 / l, 95% lymphocytes, protein 5.18 g / l, glucose 0.8 mmol / l, lactates 2.8 mmol /l

Which disease is most likely? What tests will you do to confirm the most likely disease? What will you do for treatment if your suspected disease is confirmed?

Answer 14

TBE
Clinical and biochemical CSF test + detection of specic antibodies in blood
Symptomatic treatment

Question 15

Differential diagnosis of Parkinson’s disease includes:

Answer 15

Multiple system atrophy, Corticobasal degeneration,

Progressive supranuclear palsy

Question 16

19-year-old male had a retrobulbar neuritis; then, 2 years later, he developed a urination disorder that lasted for a month. After extensive investigation the diagnosis of multiple sclerosis was made. What changes in cerebrospinal fluid are characteristic to multiple sclerosis?

Answer 16

Constant increase in IgG

Question 17

68-year-old male presents to a stroke treatment centre with symptoms of acute cerebrovascular accident that have started 2.5 hours ago. Head CT is showing no abnormalities. BP is 198/115 mmHg. What approach would you choose?

Answer 17

Labetolol 10 mg i/v and recheck BP in 10 min.

Question 18

The C5 / 6 intervertebral disc hernia is operated on:

Answer 18

Anterior discectomy, spondylodesis

Question 19

38-year-old male has had fever and diarrhea one week ago, started feeling numbness in his toes, numbness got worse, did not see medics. next morning couldn’t get out of the bed, legs weak and his hands and legs numb. On examination: Cranial nerves intact are intact, dffuse limb muscle weakness present (hands – 4 points, feet – 2 points). Biceps reflex is present, other deep tendon reflexes absent bilaterally. Pathological reflexes are absent. There is hypoesthesia in hands and in legs below the knees. What is your preliminary diagnosis?

Answer 19

Guillain – Barre syndrome

Question 20

65-year-old man reports a 6-month history of progressive weakness in the arms, recently he has also developed weakness in his legs. On neurological examination: fasciculations in the shoulder girdle muscles, atrophic thenar muscles, hand muscle strength MRC 3/5 bilaterally; brisk symmetrical deep tendon reflexes, normal muscle tone, Babinski reflex bilaterally; no sensory or coordination impairment. What preliminary diagnosis is the most likely?

Answer 20

Amyotrophic lateral sclerosis

Question 21

Nociceptive pain is:

Answer 21

A physiological response to tissue damage

Question 22

35-year-old male diagnosed MS 4 years ago with retrobulbar neuritis; no corticosteroids given. 2 years later sensory changes in hands, decrease in strength, impaired ability to write. Then treated with corticosteroids. Interferon β-1A was commenced 4 years ago. 1 year ago weakness in his right leg, constipation and urination urgency, treated with corticosteroids. Now progressive numbness in his right palm and right side of the waist. Neurological examination reveals tactile hypoesthesia in Th8 – Th10 dermatomes on the right. What treatment would you prescribe for the patient at this time?

Answer 22

Corticosteroids

Question 23

What is the most effective treatment for focal dystonias?

Answer 23

BTX-A injections

Question 24

mononeuropathies is characterized by a “hawk’s hand”

Answer 24

n.ulnaris

Question 25

77a. Empirical antibacterial therapy is prescribed for suspected lister meningitis

Answer 25

Ceftriaxone and ampicilin

Question 26

77b. For the treatment of neuroborellosis

Answer 26

ceftriaxone or doxycycline

Question 27

77c. Treatment of confirmed meningococcal meningitis

Answer 27

Penicillin

Question 28

77d. Bacterial meningitis caused by highly penicillin-resistant S.pneumoniae is treated with

Answer 28

vancomycin and ceftriaxone

Question 29

28-year-old woman complains of diplopia, weakness in her right arm and leg, numbness, disturbed gait. no fever or tick bite. fatigue and difficulty concentrating last six months. 2 years ago patient had sudden sight impairment in her left eye that lasted for a week; she did not see doctors. Rossolimo’s and Babinski’s signs positive on the right, decreased abdominal wall reflex on the right; finger-to-nose test done with intensive tremor and heel-to-shin test with ataxia with the left limbs, tilt to the left while in Romberg’s position; gait slightly ataxic-paretic.
Preliminary diagnosis? Investigations?

Answer 29

Multiple sclerosis; head and/or spinal MRI, evoked potentials, CSF examination

Question 30

Tuberculous meningitis is treated with

Answer 30

4 tuberculosis antibiotics and corticosteroids

Question 31

Imaging Signs of subacute subdural haemtoma are:

Answer 31

Hyperintense on MRI T1W sequence, Falx shape, Isodense on CT