chapter 81-82-83-84 Flashcards
A 30-year-old man presents with subacute onset of weakness which develops over about five
days. He is areflexic. MRI of the lumbar spine and plexus shows enhancement of the proximal
nerve roots. Which is the most appropriate interpretation of the findings?
A. The patient has neoplastic meningitis
B. The patient has AIDP
C. The patient has plexitis
D. The patient has CIDP
No highights
A 40-year-old male presents with pain in the right leg followed by weakness which worsens over
about a week. As the weakness reaches a plateau, the pain abates. Imaging of the-lumbar spine
and plexus is normal. EMG 4 weeks after onset shows distal denervation, with sparing of the
paraspinai muscles. He has no history or laboratory signs of diabetes, and there is no history of
cancer. Which is the most likely diagnosis?
A. Diabetic lumbar plexopathy
B. Idiopathic lumbosacral plexopathy
C. Lumbosacral plexus infiltration not seen on routine imaging
D. Neoplastic meningitis
No highights
A patient presents with severe neuropathic pain in multiple nerve root distributions. The
symptoms have developed within one week, and are rapidly worsening. She has nuchal rigidity
and mild confusion but no fever. LP shows increased white blood cells, and cytology is positive.
She has no Known history of cancer. Which is the most appropriate clinical interpretation?
A. She has neoplastic meningitis as the presenting symptoms of cancer
B. She has infectious meningitis and the cytology is false positive
C. She has encephalitis with an unidentified virus.
No highights
In evaluating a patient for a brachial plexopathy, which of the following clinical features would
suggest radiation-induced plexopathy rather than neoplastic infiltration?
1. Severe neuropathic pain
2. Upper plexus
3. Horner’s syndrome
4. Lymphedema
Select: A - 1.2. 3. B -1,3. C = 2, 4. D = 4 only. E = All
No highights
A 70-year-old man with N1DDM presents with leg weakness. He has weakness of the
quadriceps and adductors with loss of the patellar reflex. Both Achilles reflexes are suppressed,
but the remainder of the reflexes are normal. Which is the most likely diagnosis?
A. Amyotrophic lateral sclerosis
B. Diabetic polyradiculoneuropathy
C. Idiopathic lumbosacral plexitis
D. Spinal stenosis
b
A 30-year-old female develops a rash on her right leg, in approximately an L2 distribution. This
is associated with severe pain in the same distribution which has a neuropathic character. Which
is the most likely diagnosis?
A. Diabetic polyradiculoneuropathy
B. Herpes zoster
C. Lumbar disc disease
D. Lyme polyradiculitis
b
Which of the following would be appropriate treatments for a 70-year-old with herpes zoster?
1. Amitriptyline
2. Sertraline
3. Gabapentin
4. Famciclovir
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All
e
A 70-year-old man presents with severe pain and weakness in the right leg. The pain is in the
groin and radiates down into the right leg. His only other medical problem is a recent history of
DVT with resultant warfarin therapy. Which is the most likely diagnosis?
A. Diabetic amyotrophy
B. Lumbar plexitis
C. Lumbar radiculopathy
D. Retroperitoneal hematoma
d
A 68-year-old man presents with severe shoulder oain which radiates into the neck, upper chest,
and into the medial aspect of the upper arm. He has weakness of the median and ulnar-innervated
intrinsic muscles of the hand. Which of the following are reasonable differential diagnoses of
this pain7
1. Carpal tunnel syndrome
2. Cervical radiculopathy
3. Monomelic amyotrophy
4. Brachial plexopathy
Select: A = 1, 2, 3. B = i. 3 C = 2. 4. D =4 only. E - All
d
The patient in the above question has MRI of the cervical spine which is normal and MRI of the
plexus which shows a mass extending from the apex of the lung in to the lower brachial plexus.
Which is the most diagnosis?
A. Lymphoma
B. Non-small cell lung cancer
C. Mesothelioma
D. Small cell lung cancer
b
A 23-year-old female presents with 3 weeks of weakness most prominent distally, dysesthesias
and paresthesias. Examination is most remarkable for areflexia. Which is the most likely
diagnosis?
A. Acute inflammatory demyelinating polyradiculoneuropathy
B. Chronic inflammatory demyelinating polyradiculoneuropathy
C. Pick paralysis
D. Porphyria
a
A 45-year-old female presents with numbness of both hands on digits 4 and 5, and is found on
EMG to have bilateral ulnar neuropathies with relative slowing across the elbow plus signs of
mild peripheral polyneuropathy Which is the most likely diagnosis?
A Diabetic neuropathy
B. Guillain-Barre syndrome
C. Hereditary sensorimotor neuropathy
D. Vasculitis
a
Which of the following are reasonable clinical indications for nerve biopsy?
1. Amyloidosis
2. Vasculitis
3. Sarcoidosis
4. Guiilain-Barre syndrome
Select: A - 1.2. 3. B = !, 3. C = 2, 4.D - A oi.lv. !• - Ail
a
For the following questions, select the most likely diagnosis from the following list. Each question presents a type of neuropathy. A. ALS B. CIDP C. Critical illness neuropathy D. Diabetic neuropathy E. Entrapment mononcuropathy F. Guillain-Barre syndrome G. Hereditary neuropathy H. MMN I. Vasculitis
A 56-year-old female with COPD is in the ICU for two weeks on. the ventilator and develops
diffuse weakness and depressed refiexes. Tone is diffusely decreased.
c
For the following questions, select the most likely diagnosis from the following list. Each question presents a type of neuropathy. A. ALS B. CIDP C. Critical illness neuropathy D. Diabetic neuropathy E. Entrapment mononcuropathy F. Guillain-Barre syndrome G. Hereditary neuropathy H. MMN I. Vasculitis
A 30-year-old male presents with progressive asymmetric weakness mainly affecting distal limb
muscles. There are no pyramidal tract signs and no sensory symptoms. Tendon reflexes are
depressed, but only absent at the ankle.
h
