chapter 85-86-87 Flashcards
The figure shows a muscle biopsy of a patient with weakness. This is a myosin ATPase stain (pH
9.4). Which of the following describes the biopsy results?
A. Inflammatory myopathy
B. Re-innervation
C. Muscular dystrophy
D. Normal muscle
b
The figure shows a muscle biopsy of a patient with weakness. This is a myosin ATPase stain (pH
9.4). Which of the following describes the biopsy results?
A. Inflammatory myopathy
B. Denervation
C. Muscular dystrophy
D. Normal muscle
d
internal nuclei are seen in the muscle fibers of the biopsy specimen shown below. Internal nuclei
are seen in which of the following conditions?
A. Muscular dystrophies
B. Denervation
C. Normal muscle
D. All of these
d
The picture is of a man with the same disorder shown in the preceding biopsy specimen. Which is the most likeiy diagnosis? A.Congenital muscular dystrophy B. Facioscapulohumeral dystrophy C. Myotonic dystrophy D. Oculopharyngeal dystrophy
c
A child with a recent history of recurrent migraine-type headaches presents with hemiparesis.
Examination shows mild proximal weakness. Which of the following diagnoses is suggested by
this presentation?
A. Adrenoleukodystrophy
B. Kearns-Sayre syndrome
C. MELAS
D. MERRF
c
A 17-year-old male presents wuh retinitis pigmentosa, external ophthalmoplegia, and is found to
to have heart block. Mild proximal sal ness leads to a muscle biopsy, the results which are shown
below. This is a modified Gomori trichrome stain.
Which is the most likely diagnosis?
A. Adrenoleukodystrophy
B. Kearns-Sayre syndrome
C. MELAS
D. MERRF
b
Which of the following EMG findings would be expected in patients with congenital fiber-type
disproportion?
1. Fibrillation potentials
2. Reduced recruitment
3. Positive sharp waves
4. Brief, small-amplitude oolyphasic motor unit potentials
Select: A = 1. 2, 3. B = 1. 3. C = 2, 4. D = 4 only. E = All
d
A 60-year-old female with progressive proximal weakness is found to have elevated CPK and
myopathic findings on EMG. Muscle biopsy shows muscle fibers at varying stages of
degeneration and necrosis. There is no fiber-type grouping. There is perivascular inflammation,
but no visible inflammation within the muscle fasciculi. Which is the most likely diagnosis?
A. Limb-girdle muscular dystrophy
B. Motor neuron disease
C. Myasthenia gravis
D. Polymyositis
d
Which of the following is the most effective treatment for inclusion body myositis? A. Azathioprine B. intravenous immunoglobulin C. Plasma exchange D. Prednisone E. None of these
d
A 65-year-old female presents with pain in the shoulders and arms with a lesser degree of pain in
the legs. The pain is in the muscles, with tenderness with palpation. CK is normal. ESR is 80.
EMG is normal. Muscle biopsy shows type 2 fiber atrophy. Which is the rroost likely diagnosis?
A. Dermatomyositis
B. Fibromyalgia
C. Polymyalgia rheumatica
D. Polymyositis
c
A premature newborn of 32 weeks conceptional age is evaluated for possible subtle seizure
activity. There are no EEG correlates to the eye and limb movements which are of concern to the
neonatal 1CU staff, but there are multifocal sharp transients. They occur singly, and with no
consistent location. Which is the best interpretation of these findings?
A. Familial neonatal seizures
B. Hypoxic encephalopathy
C. Rolandic seizures
D. Normal
d
A child is admitted to the neonatal ICU because of hypoxic encephalopathy following a difficult
birth. Conceptional age is 38 weeks. She is awake but irritable and has an exaggerated Moro and
tendon reflexes. What would you advise the parents about anticipated recovery?
A. Recovery is expected
B. Recovery is not expected, the child will be left with motor and/or cognitive deficits
C. Recovery cannot be predicted at this stage
a
An EEG is performed on the patient described above, and shows a mixed frequency background
with an alternating pattern -epochs of higher voltage interspersed by-epochs of lower voltage,
each lasting a few seconds. What is the implication of this pattern?
A. Normal pattern
B. Indicates mild HIE
C. Indicates severe HIE.
D. Indicates episodic non-convulsive seizures
a
Which of the following are potential long-term effects of severe hypoxic-ischemic
encephalopathy in the newborn?
1. Mental retardation
2. Spasticity
3. Seizures
4. Microcephaly
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E - All
e
Which of the following is most sensitive for demonstration of hypoxic-ischemic cerebral injur/ in neonates'? A. CT B. EEG C. MRI D. Ultrasound
c
Which of the following are implicated in pathogenesis of periventricular and intraventricular
hemorrhage in the newborn?
1. Coagulopathy
2 Fluctuation in cerebral blood flow
3. Hypertension
4. Poor vascular support
Select: A = 1,2, 3. u = 1, 3. C = 2, 4. D = 4 only. E- All
e
Which is the most common clinical presentation of CMV infection in the newborn? A. Chorioretinitis B. Hepatosplenomegaly C. Microcephaly D. Normal
d
Which of the following arc potential routes for infection of infants with HIV? A. Breast feeding B. Labor and delivery C. Transplacental D. Any of these
d
A newborn child presents with weakness of the left arm. She has loss of shoulder abduction and
external rotation, and loss of elbow flexion and hand extension. What type of lesion does she
have?
A. Cervical spinal cord injury
B. Upper brachial plexus (Erb’s palsy)
C. Lower brachial plexus (Klumpke’s palsy)
D. Radial nerve injury
b
A newborn child develops seizures during the first postnatal day. CT scan and CSF are normal.
Considering the maternal history, substance withdrawal is considered. Which of the following
agents is most likely to be the offending agent?
A. Codeine
B. Pentazocine
C. Phenobarbital
D. Propoxyphene
d
A 77-year-old pregnant female presents with leg cramps. Examination shows no signs of
peripheral neuropathy and there are no electrolyse abnoimalities. Self-help guidelines are
ineffective. What is the most appropriate treatment?
A. Diazepam
B. Levodopa
C. Magnesium
D. Ropinerole
c
A patient with carpal tunnel syndrome has marked increase in symptoms during pregnancy. She
already has tried wrist splints. Examination shows marked weakness of the abductor pollicis
brevis muscle. Which is the next best approach to treatment?
A. Anti-inflammatory treatment and continued use of wrist splints
B. Corticosteroid injection into the carpal tunnel
C. Corticosteroids by systemic administration
D. Endoscopic surgery
d
Pregnancy commonly worsens which of the following conditions?
1. Carpal tunnel syndrome
2. CIDP
3. Polymyositis
4. Migraine
Select: A - I, 2, 3. B = 1, 3’. C = 2,4. D = 4 only. E - All
a
A woman is seen for follow-up of stroke which occurred during pregnancy. She has recovered
well and there is virtually no deficit. Laboratory studies for valvular heart disease, vasculitis,
SI.E, antiphospholipid antibody syndrome, etc., are all negative. How would you advise her
about the risk of stroke during a subsequent pregnancy?
A. The risk of stroke is not substantially increased
B. The risk of stroke is high and continued warfarin treatment during conception and pregnancy
is essential
C. The risk of stroke is increased and parenteral anticoagulation is needed
a
A woman is found to have an A.VM and it is treated with stereotactic radiosurgery. How would
you advise her regarding subsequent pregnancy?
A. Wait two years before becoming pregnant
B. Wait two months before becoming pregnant
C. Avoid pregnancy even though she has had the radiosurgery
a
Which of the following statements is true regarding pregnancy and epilepsy?
1. AEDs increase the risk of birth defects
2. The greatest risk of birth defects is from exposure to AEDs in the first trimester
3. Foiate supplementation prior to and during early gestation reduces the incidence of birth
defects
4. About 90% of epileptic women deliver normal babies
Select: A = 1, 2, 3. B = 1, 3. C = 2, 4. D = 4 only. E = All
e
A woman with complex partial seizures with secondary generalization is contemplating
pregnancy. The combination of valproate and oxcarbazepine completely controls the seizures.
You advise her about folate supplementation. How would you advise her regarding medication
management for the seizures?
A. Since she has good seizure control, the combination should be maintained
B. Monotherapy with OXC should be tried before becoming pregnant
C. Monotherapy with VPA should be tried before becoming pregnant
b
A pregnant woman is maintained during her pregnancy on carbamazepine. There are no
complications. Is vitamin K supplementation needed during the last stages of pregnancy?
A. Yes
B. No
a
A woman late in the third trimester develops increased blood pressure and proteinuria. She is
noted to have elevated LFTs, low platelets, and hemolysis. Which is the appropriate treatment?
A. Magnesium administration and delivery soon
B. Magnesium administration and delivery’ when preeclamptic symptoms resolved
C. Labetolol and phenytoin therapy
a
