chapter 60-61

Question 1

A 36-year-old woman comes to the clinic for counseling regarding her chances of having
multiple sclerosis. She has an identical twin with MS. The presenting patient has no symptoms or
signs to suggest MS. Which is appropriate counseling regarding chance of MS?
A. The risk of having MS at some time in life is almost 100%
B. The risk of developing MS is increased but still less than 50%
C. There is no increased risk or MS in this patient

Answer 1

b

Question 2

Fatigue is extremely common in patients with MS. Which statement correctly describes the
relationship between fatigue and MS?
A. Severity of fatigue correlates with frequency of attacks
B. Severity of fatigue correlates with overall burden of the disease
C. Fatigue has no correlation with the severity of the disease.

Answer 2

c

Question 3

A patient presents for evaluation of possible - MS. He has a history of optic neuritis
followed several years later by an episode of paraplegia from which he did not completely .
recover. He now has diplopia with an internuclear ophthalmoplegia plus hemiataxia. MRI shows
multiple areas of increased intensity on T2-weighted images. Which additional information is’
required to establish a diagnosis of MS?
A. CSF analysis
B. Evoked potentials
C. PET scan
D. No studies required

Answer 3

d

Question 4

A 32-year-old female comes for evaluation of headaches which seem to be migrainous. She
carries an MRI with her for you to review which shows three Small areas of increased signal
intensity on T2-weighted images which do not enhance. Which is the appropriate clinical
formulation?
A. The patient has definite MS
B. The patient has possible MS and EP and CSF analysis are required
C. The patient has no clinical features of MS and no additional study is needed

Answer 4

c

Question 5

Which of the following statements is true regarding the relapse rate after a single demyelinating
episode in a patient who meets criteria for MS on the basis of MRI and/or CSF examination?
A. Relapse is inevitable
B. Relapse is likely, but there is a possibility of no subsequent attacks
C. Relapse rate is dependent on whether the patient receives methyiprednisolone for the single
attack

Answer 5

b

Question 6

Which of the following statements are true regarding pregnancy and MS?
A. Relapses are increased in pregnancy and in the postpartum period
B. Relapses are reduced late in pregnancy and increased in the postpartum period
C. Relapses are reduced late in pregnancy and in the postpartum, period
D. Relapses are increased late in pregnancy and reduced in the postpartum period

Answer 6

b

Question 7

Which of the following features makes for a better prognosis in MS.
1. Female
2. Early onset
3. Initial relapsing course
4. Initial sensory symptoms
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All

Answer 7

e

Question 8

A child presents with optic neuritis and has an MRI which is normal. What is the estimated risk
of developing MS?
A. Near zero
B. Less than 30%
C. About 50%
D. Near 100%

Answer 8

b

Question 9

Which statement describes the implication of gadolinium-enhancement on MRI for MS.
A. Active MS plaques enhance for several weeks
B. MS plaques enhance indefinitely
C. MS plaques do not enhance with gadolinium
D. Gadolinium is contraindicated for patients with suspected MS

Answer 9

a

Question 10

Which of the following statements are true regarding CSF in MS.
1. Protein is usually elevated
2. Cligoclonal bands are specific for MS
3. Decreased IgG index is characteristic, but not diagnostic of MS
4. There is no disease-specific antigen in the CSF
Select: A = 1.1. 3. B = 1. 3. C = 2. 4. D = 4 only. E = All

Answer 10

d

Question 11

Which of the evoked potentials is the least helpful for identification of clinically-silent lesions’?
A. Auditory brainstem response
B. Visual evoked response
C. Somatosensory evoked potentials

Answer 11

a

Question 12

Which statement is correct regarding the use of immunomodulatory therapies such as interferons
and gladramer in patients with relapsing MS?
A. All patients with relapsing MS should be offered one of these agents
B. Patients with frequent relapses should be offered one of these agents
C. These agents should be reserved for patients with progressive disease
D. Interferons should be administered until neutralizing antibody formation is documented,then
the medication should be changed to glatiramer

Answer 12

a

Question 13

Which of the following factors predisposes to acute mountain sickness?
1.Vascular risk factors
2. Increased intracranial pressure before the ascent
3. Ethanol use
4. Certain medications such as acetazolamide
Select: A = 1,2,3. B = 1, 3. C = 2, 4. D = 4 only. E = All

Answer 13

a

Question 14

Which of the following is not helpful for management of patients with cerebral edema from
anoxia?
A. Hyperventilation
B. Mannitol
C. Corticosteroids
D. Ventriculostomy
E. None are helpful

Answer 14

e

Question 15

A patient with encephalopathy after carbon monoxide intoxication has initial improvement, then
later decline in alertness. Which of the following is most likely?
A. Late development of intracranial hemorrhage
B. Late development of cerebral infarction
C. Delayed post-anoxic demyelination

Answer 15

c

Question 16

You are asked to evaluate a middle-aged woman in the CCU because of coma following out-ofhospital
cardiac arrest and resuscitation. Examination more than 24 hours after the event shows
absent pupillary light reflex, absent corneal reflex, and absent conjugate roving gaze. When
speaking with the family, what is the prognosis for good neurologic recovery?
A. Zero
B. 20% or less
C. 50%
D. Cannot be determined

Answer 16

a

Question 17

What is the role of cerebral blood flow studies and EEG in diagnosis of brain death?
A Confirmatory tests abolish the period of observation between two examinations
B. Confirmatory tests reduce the required period of observation
C. Confirmatory tests are supportive, but do not alter the brain death criteria for examination or
observation

Answer 17

b

Question 18

Which of the following would be appropriate treatment for patients with post-anoxic
myoclonus?
1. Clonazepam
2. Midazolam
3. Lorazepam
4. Valproate
Select: A= 1,2, 3. B = 1,3. C = 2, 4. D - 4 only. E - All -

Answer 18

e

Question 19

A patient with post-anoxic coma has an EEG 48 hours after the arrest which shows widespread
alpha-frequency activity which does not respond to passive eye opening, and is invariant during
the examination. What is the clinical significance of these finding?
A. Good prognosis
B. Dismal prognosis
C. No prognostic indication
D. Finding is artifactual

Answer 19

b

Question 20

A patient recovering from cardiac arrest develops extrapyramidal findings as he shows
increasing motor function. The clinical appearance is parkinsonian. What response to
medications is expected?
A. Dopa is helpful but agonists are of little use
B. Dopamine agonists are helpful but dopa is of little use
C. Dopaminergic agents help rigidity and bradykinesia but not tremor
D. Dopaminergic agents are usually of little benefit

Answer 20

d

Question 21

A patient who has sustained a cardiac arrest appears to be awakening from coma. He moves and
opens his eyes, but does not follow commands. He yawns occasionally and twists his mouth.
There are sleep-wake cycles. He has extensor posturing of the extremities with stimulation.
Plantar responses are upgoing with triple flexion. Which is the most likely clinical assessment?
A He is arousing and should awaken soon
B He is locked-in with brainstem infarction
C. He is awake but has a high cervical cord injury giving the pyramidal tract signs
D. He is developing the persistent vegetative state

Answer 21

d

Question 22

An EEG is performea on the patient described above. What is the expected finding?
A. Isoelectric
B. Diffuse slowing
C. Normal alpha
D. Normal alpha through, with reduced reactivity

Answer 22

b