Inflammatory disorders, MS

Question 1

Acute stage of viral meningitis is not associated with:
A) common negative clinical findings of cranial CT
B) negative findings on EEG exam
C) cloudy liquor, elevated cell and protein count
D) elevated lymphocyte count in the CSF

Answer 1

C) cloudy liquor, elevated cell and protein count

Question 2

Acute stage of purulent meningitis is not associated with:
A) epileptic seizures
B) confusion
C) violent headaches
D) elevated lymphocyte and monocyte count in the CSF

Answer 2

D) elevated lymphocyte and monocyte count in the CSF

Question 3

Characteristics of Guillain–Barre syndrome include:
A) segmental demyelinisation may be accompanied by axonal damage
B) axonal lesion does not occur
C) only sensory axonal lesion occurs
D) damage to myelin sheeth is always associated with axonal damage

Answer 3

A) segmental demyelinisation may be accompanied by axonal damage

Question 4

Useful in prion disease treatment:
A) penicillin
B) AZT (azidothymidin)
C) macrolides
D) none of the above

Answer 4

D) none of the above

Question 5

Initial stage of optic neuritis is characterized by central scotoma and:
A) papillary hyperaemia
B) papillary oedema
C) slight blur in vitreous humor
D) all of the above
E) none of the above

Answer 5

E) none of the above

Question 6

Observed meningitis symptoms may include:
A) vomiting
B) avoiding light
C) signs of meningeal irritation
D) all of the above
E) none of the above

Answer 6

D) all of the above

Question 7

Characteristic symptoms of encephalitis, except:
A) headache
B) decreased protein content in CSF
C) cranial nerve symptoms
D) changes in sleep rhythm
E) confusion, fever, headache, epileptic seizures

Answer 7

B) decreased protein content in CSF

Question 8

Which examination is least informative in polyneuropathy?
A) neurography
B) examination of reflexes
C) muscle biopsy
D) nerve biopsy

Answer 8

C) muscle biopsy

Question 9

Of the following diagnostic procedures, which is most commonly pathological in Multiple Sclerosis?
A) eye movement examination
B) cranial CT
C) EEG
D) myelography

Answer 9

A) eye movement examination

Question 10

Diagnostic criteria for NMO (neuromyelitis optica) are:
1) Clinical signs of optic neuritis and/or spinal lesion
2) Presence of aquaporin-4 antibodies in serum
3) Presence of LTM (extensive myelitis overlying several segments) on spinal MR findings
4) Presence of OGP (sign of intrathecal IgG synthesis) in CSF

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 10

A) answer 1, 2 and 3 correct

Question 11

Leading clinical signs of acute Guillain–Barre syndrome are:
1) possible cranial nerve lesion
2) ascending paresis
3) flaccid or absent deep reflexes
4) muscular atrophy

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 11

A) answers 1, 2 and 3 are correct

Question 12

Characteristic alterations in the CSF in multiple sclerosis:
1) increased glucose content
2) elevated levels of relative immunglobulin- IgG values
3) increased polymorphonuclear leucocyte count in 1/3 of cases
4) increased protein content in app. 1/3 of cases

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 12

C) answer 2 and 4 correct

Question 13

Characteristic symptoms of Guillain–Barre syndrome are:
1) flaccid paresis, absent deep reflexes
2) sensory deficit does not occur
3) cell-protein dissociation is commonly observed in the CSF
4) survival extends usually for a few months, maximum two years

A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 correct
E) all of the answers correct

Answer 13

B) answers 1 and 3 correct

Question 14

Characteristics of multiple sclerosis are:
1) it is more common is white people
2) it is most common in a relapse-remission pathological form
3) multifocal neurological symptoms
4) first symptoms usually present over age 50

A) answer 1, 2 and 3 are correct
B) answer 1 and 3 are correct
C) answer 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 14

A) answer 1, 2 and 3 are correct

Question 15

Common clinical signs of multiple sclerosis are:
1) paraesthesia
2) optic neuritis
3) paresis
4) ataxia

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 15

E) all 4 answers are correct

Question 16

Common chronic symptoms of multiple sclerosis are:
1) pathological tiredness (fatigue)
2) disordered optic pathways and eye movement
3) vigorous reflexes
4) epilepsy

A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 correct
E) all of the answers correct

Answer 16

A) answers 1, 2 and 3 correct

Question 17

Common chronic symptoms of multiple sclerosis may be:
1) dizziness
2) confabulation
3) weakness in the extremities, spasticity
4) brain oedema

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 17

B) answers 1 and 3 are correct

Question 18

Useful diagnostic procedures of multiple sclerosis:
1) patient’s medical history and detailed neurological examination
2) cranial MRI examination
3) evoked potential tests
4) CSF test

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 18

E) all 4 answers correct

Question 19

The following patients are at an increased risk for multiple sclerosis:
1) young adults
2) women
3) North-European whites
4) a person who has a close relative suffering from multiple sclerosis

A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 19

E) all 4 answers are correct

Question 20

Diagnostic specificities of multiple sclerosis (MS):
1) high IgG index in the CSF is specific for MS
2) extended latency values on VEP (visually evoked potentials) are specific for MS
3) gadolinium accumulating white matter lesions detected on MRI are specific for MS
4) dissemination of clinical signs in space and time is prime criterion for the diagnosis

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 20

D) only answer 4 is correct

Question 21

During the treatment of multiple sclerosis relapse:
1) high dose intravenous methylprednisolon for 3–5 days are administered
2) steroid use is not prescribed in the treatment of psychosis
3) in severe diabetes or acute infection, steroids are not administered
4) beta-interferon is administered instantenously

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 21

A) answer 1, 2 and 3 correct

Question 22

Spasticity in multiple sclerosis may be reduced using the following medications:
1) dantrolen
2) tizanidine
3) botulinumtoxin
4) baclofen

A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 is correct
E) all of the answers are correct

Answer 22

C) answers 2 and 4 correct

Question 23

The following drugs are used to reduce multiple sclerosis relapse rate:
1) azathioprin
2) ABCR self-administered injections (beta-interferons, glatiramer acetate)
3) INH (isonicid)
4) monoclonal antibodies (natalizumab, alemtuzumab)

A) answers 1, 2 and 3 are correct
B) answers 1 and 3 are correct
C) answers 2 and 4 are correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 23

C) answers 2 and 4 are correct

Question 24

In multiple sclerosis, introduction of immunomodulatory treatment should be indicated:
1) in relapsing-remitting clinical form, during the active phase
2) in the primary, progressive form
3) in the early stage, until the patient retains mobility
4) in a secondary, progressive form, over age 50

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 24

B) answer 1 and 3 correct

Question 25

Side effects of interferon treatment:
1) fever and influenza-like symptoms at the beginning of treatment
2) may increase symptoms of depression
3) local reaction on the site of injection
4) it increases blood pressure

A) answers 1, 2 and 3 correct
B) answers 1 and 3 correct
C) answers 2 and 4 correct
D) only answer 4 is correct
E) all 4 answers are correct

Answer 25

A) answers 1, 2 and 3 correct

Question 26

Link the abnormal laboratory results with the matching pathological clinical picture.
A) acute Guillain–Barré syndrome
B) multifocal motor neuropathy
C) multiple sclerosis
D) adrenoleukodystrophy

NEU - 3.35 - GM1 antibodies appear in the serum or CSF
NEU - 3.36 - Oligoclonal gammopathy is present in the CSF
NEU - 3.37 - Cell-protein dissociation in the CSF is typical
NEU - 3.38 - Long chain saturated fatty acids accumulate in the serum

Answer 26

35- B
36- C
37- A
38- D

Question 27

Match the following:
A) progressive multifocal leukoencephalopathy (PML)
B) tuberculosis
C) aspergillosis
D) toxoplasmosis

NEU - 3.39 - A JC virus infection, acquired in childhood, usually plays a part in the disease
NEU - 3.40 - Fungal disease
NEU - 3.41 - Domestic cats play a part in its spreading
NEU - 3.42 - It can cause septic embolism in the brain

Answer 27

39- A
40- C
41- D
42- C

Question 28

Match the following:
A) Ramsay Hunt syndrome
B) Bell’s palsy
C) Guillain-Barré syndrome
D) Melkersson-Rosenthal syndrome

NEU - 3.43 - Sudden onset of idiopathic facial paralysis
NEU - 3.44 - Facial paralysis caused by the herpes of the ear canal
NEU - 3.45 - Facial paralysis with swollen lips
NEU - 3.46 - Bilateral facial paralysis may occur

Answer 28

43- B
44- A
45- D
46- C

Question 29

Based on the signs and symptoms, the case can be:
A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent.

A) purulent meningitis
B) brain abscess
C) brain tumor of metastatic origin
D) all of the above
E) none of the above

Answer 29

D) all of the above

Question 30

Which of the following examinations is to be carried out first?
A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent.
A) chest X-ray
B) ECG
C) EEG
D) CT
E) lumbar puncture

Answer 30

D) CT

Question 31

If the CSF examination will take place, the case of purulent meningitis stands, if:
A 48 years old male patient, who regularly consumes alcohol, became restless in the morning on the day of the hospital admission, and suffered a Grand Mal Seizure. He was scheduled for a surgery due to colon cancer half a year ago. Three days prior to the admission, he experienced a fever and his temperature rose to 38 ° C. Upon examination, a mild stiffness in the neck, a horizontal nystagmus (while looking in both directions), and a moderate limb and trunk ataxia were discovered. He was slightly somnolent.
1) clear CSF
2) increased amount of white blood cells
3) oligoclonal gammopathy
4) 1 g/l quantities of total protein

A) answer 1, 2 and 3 correct
B) answer 1 and 3 correct
C) answer 2 and 4 correct
D) only answer 4 correct
E) all 4 answers correct

Answer 31

C) answer 2 and 4 correct

Question 32

The brain contusion almost always involves a loss of consciousness, and no abnormalities are visible on the CT scan and the CSF is often bloody.
A) true
B) false

Answer 32

B) false

Question 33

The postoperative survival of patients suffering from glioblastoma multiforme usually ranges from a few months up to a year or two.
A) true
B) false

Answer 33

A) true

Question 34

The number of cells increases and protein content decreases in the CSF during encephalitis.
A) true
B) false

Answer 34

B) false

Question 35

Brain abscess is often caused by an extracerebral premise.
A) true
B) false

Answer 35

A) true

Question 36

Cauda equina syndrome is not pyramidal.
A) true
B) false

Answer 36

A) true

Question 37

The visual evoked potential (VEP) is still intact in most patients suffering from multiple sclerosis.
A) true
B) false

Answer 37

B) false

Question 38

Generally, a vertical nystagmus can be observed in the case of vertigo of peripheral origin.
A) true
B) false

Answer 38

B) false

Question 39

The level of the anti-measles antigens rises in the CSF during neuromyelitis optica.
A) true
B) false

Answer 39

B) false

Question 40

Multiple sclerosis is a disease of unknown etiology, in which environmental, genetic and immunological factors may play a role in its development.
A) true
B) false

Answer 40

A) true

Question 41

Multiple sclerosis is an autoimmune disease, in which T-cell mediated immune response has an important role.
A) true
B) false

Answer 41

A) true

Question 42

With multiple sclerosis, the myelin sheath suffers a segmental damage, the axon, however, remains in good condition.
A) true
B) false

Answer 42

B) false

Question 43

The most common form of multiple sclerosis is the manifestation with relapses and remitting.
A) true
B) false

Answer 43

A) true

Question 44

In about 10% of the multiples sclerosis diseases, it occurs in a primary progressive form from the beginning.
A) true
B) false

Answer 44

A) true

Question 45

The relapsing-remitting multiple sclerosis with the later stage of the clinical course develops into a secondary progressive form.
A) true
B) false

Answer 45

A) true

Question 46

The primary progressive form of multiple sclerosis can develop into a secondary progressive form.
A) true
B) false

Answer 46

B) false

Question 47

Generally, the prognosis of the primary progressive form of the disease is worse than the relapse-remitting form or the secondary progressive form of multiple sclerosis.
A) true
B) false

Answer 47

A) true

Question 48

With appropriate treatment and care, the life expectancy of patients with multiple sclerosis is only a few years less than that of the general population of the same age.
A) true
B) false

Answer 48

A) true

Question 49

The diagnosis of multiple sclerosis is not of clinical symptoms, but is based on the CSF and the MRI test results.
A) true
B) false

Answer 49

B) false

Question 50

The cranial MRI is important, but not specific, in the effective diagnosis of multiple sclerosis.
A) true
B) false

Answer 50

A) true

Question 51

Without specific treatment, neuromyelitis optica leads to serious permanent damage or even death.
A) true
B) false

Answer 51

A) true

Question 52

Neuromyelitis optica is a T cell-mediated autoimmune disease, like multiple sclerosis and the treatment is identical.
A) true
B) false

Answer 52

B) false

Question 53

In the background of epileptic illnesses, the inflammatory disease of the nervous system can never be found.
A) true
B) false

Answer 53

B) false