MEDSURG2: 3rd Shifting Flashcards
Which among the following is used for the pharmacologic diagnostic test in Myasthenia gravis?
A. Physostigmine
B. Pyridostigmine
C. Edrophonium HCI
D. None of the above
C. Edrophonium HCI
Acute Panautonomic Neuropathy can present with the following EXCEPT?
A. Hyperreflexia
B. Orthostatic hypotension
C. Postprandial bloating
D. Dizziness
A. Hyperreflexia
Which among the following is most often reported as the antecedent event in Guillain-Barre syndrome?
A. Head trauma
B. Vaccination
C. Surgery
D. Gastrointestinal infection
D. Gastrointestinal infection
Which among the following is the most commonly used drug for treatment of Myasthenia Gravis?
A. Neostigmine
B. Pyridostigmine
C. Physostigmine
D. Prednisone
B. Pyridostigmine
Moderate and generalized skeletal weakness with bulbar involvement in myasthenia gravis is classified as Osserman Class?
A. 2A
B. 2B
C. 3
D. 4
B. 2B
Which group of muscles gets preferentially weak in Myasthenia Gravis?
A. Shoulder muscles
B. Pelvic girdle muscles
C. Extraocular muscles
D. Bulbar muscles
C. Extraocular muscles
What is a characteristic Cerebrospinal fluid analysis findings in Guillain Barre Syndrome?
A. Normal CSF cell count with elevated CSF sugar
B. Pleocytosis with elevated protein
C. Elevated protein with normal CSF cell count
D. Presence of oligoclonal bands
C. Elevated protein with normal CSF cell count
Which among the following electrodiagnostic test is best for diagnosing Myasthenia Gravis?
A. Electromyography
B. Evoked potential
C. Repetitive nerve stimulation
D. Single fiber EMG
D. Single fiber EMG
Which treatments are proven effective for GBS?
A. IVIg and plasmapheresis
B. Plasmapheresis and steroids
C. Plasmapheresis, Steroids, and IVIg
D. Steroid and IVIg
A. IVIg and plasmapheresis
Which CSF finding is consistent with Guillain-Barre syndrome?
A. Normal CSF protein
B. WBC <5 lymphocytes
C. Elevated CSF sugar
D. High CSF pressure
B. WBC <5 lymphocytes
The following clinical findings can be seen in GBS EXCEPT?
A. Depressed deep tendon reflexes
B. Ascending weakness
C. Fasciculations
D. Paresthesias in toes and fingers
C. Fasciculations
Which of following clinical presentations would not be suggestive of myasthenia or NMJ disorder?
A. Dysphagia
B. Drooping of one eyelid with anisocoria
C. Respiratory crisis
D. None of the above
B. Drooping of one eyelid with anisocoria
The following are part of the triad of Miller-Fisher variant of Guillain-Barre syndrome, EXCEPT:
A. Ophthalmoplegia
B. Ascending weakness
C. Areflexia
D. Ataxia
B. Ascending weakness
The most common symptom/sign seen in fully developed GBS is?
A. Paresthesia
B. Areflexia
C. Facial weakness
D. Sensory loss
B. Areflexia
Which among the following is NOT a pre-synaptic neuromuscular junction disease?
A. Myasthenia Gravis
B. Botulism
C. Lambert Eaton Myasthenic Syndrome
D. All of the above
A. Myasthenia Gravis
TRUE OR FALSE: In myasthenia gravis, acetylcholine is released in sufficient amount.
True
Albuminocytologic dissociation in the cerebrospinal fluid among patients was first described by?
A. Barre and Strohl
B. Miller and Fisher
C. Adams and Asbury
D. Landry and Waldorp
A. Barre and Strohl
Which is NOT a poor prognostic feature of GBS?
A. Male sex
B. Rapid onset
C. With preceding diarrhea
D. Older age
A. Male sex
The following factors can worsen Myasthenia Gravis symptoms; EXCEPT?
A. Hypothyroidism
B. Infection
C. Pregnancy
D. None of the above
D. None of the above
Focal degeneration of the myelin sheath with sparing of the axon is called
A. Axonal degeneration
B. Retrograde degeneration
C. Segmental degeneration
D. Wallerian degeneration
C. Segmental degeneration
Thymoma in MG is most commonly seen in which age group?
A. Below 30 y/o
B. Between 30-60 y/o
C. Above 60 y/o
D. None of the above
B. Between 30-60 y/o
Match the GBS variant with the associated antibody found in each disease.
- Pure sensory variant
- Miller Fisher Syndrome
- Acute motor sensory axonal neuropathy
- Acute Motor Axonal Neuropathy
A. GQ1b antibody
B. GD1b antibody
C. GM1 antibody
D. None
- B
- A
- D
- C
Which of the following antibiotics causes sensory polyneuropathy due to subsequent vitamin B6 deficiency?
A. Metronidazole
B. Isoniazid
C. Ethambutol
D. Ceftazidime
B. Isoniazid
Which of the following viral pathogens causes Progressive Multifocal Leukoencephalopathy?
A. Epstein Barr Virus
B. Herpes Virus
C. JC Papilloma Virus
D. Rubeola
C. JC Papilloma Virus
The following are inclusions in the clinical criteria for multiple sclerosis, except?
A. Objective deficits are present on neurologic examination
B. Onset between age 10-50 years
C. Two separate attacks onset of symptoms is separated by at least 1 month
D. Symptoms must involve the gray matter
D. Symptoms must involve the gray matter
What is the most common cause of Erb’s palsy?
A. Tumoral metastasis
B. Shoulder dystocia
C. Sports injury
D. Vehicular accidents
B. Shoulder dystocia
TRUE OR FALSE: Fasciculations and cramps are prominent features in most neuropathies
False
Acute disseminated encephalomyelitis presenting as cerebellitis usually follows which childhood infection?
A. Chickenpox
B. German measles
C. Mumps
D. Toxoplasmosis
A. Chickenpox
Which type of demyelinating disease was commonly seen among Filipinos in the past?
A. Multiple sclerosis
B. Schilder’s sclerosis
C. Balo’s sclerosis
D. Acute disseminated type
C. Balo’s sclerosis
Which clinical feature is not suggestive of multiple sclerosis?
A. Apraxia
B. Aphasia
C. Dysequilibrium
D. Seizures
D. Seizures
Which statement correctly refers to Marchiafava-Bignami disease
A. it usually occurs due to rapid correction of hyponatremia
B. it has a predilection to demyelinate the pons
C. it is usually due to toxic effect of alcohol
D. it has a predilection to demyelinate the cerebellum
C. it is usually due to toxic effect of alcohol
The acute development of symptoms and signs of neurologic dysfunction in motor, sensory, or autonomic nerves and nerve tracts of the spinal cord is known as?
A. transverse myelitis
B. acute disseminated encephalomyelitis
C. devic’s disease
D. myelopathy
A. transverse myelitis
What is the most common inheritance pattern of Charcot-Marie-Tooth Type 1?
A. autosomal recessive
B. X-linked recessive
C. X-linked dominant
D. autosomal dominant
D. autosomal dominant
Which of the following differentiates the CSF findings of diffuse cerebral sclerosis of Schilder from multiple sclerosis?
A. abnormal cell count
B. absence of oligoclonal bands
C. low CSF IgG/Serum IgG index
D. very high protein
B. absence of oligoclonal bands
Most common nerve affected in carpal tunnel syndrome is?
A. axillary
B. median
C. ulnar
D. radial
B. median
Your patient has had two attacks of MS but only one lesion on MRI. Based on the 2017 McDonald Criteria for multiple sclerosis, what will be the additional criterion/criteria for this patient to be labelled as multiple sclerosis?
A. dissemination in space
B. dissemination in time
C. dissemination in time and space
D. no need for additional criterion
A. dissemination in space
A 27-year-old Filipina presented with sudden onset of paraplegia and (+) sensory level at T8. This was accompanied by bladder and bowel disturbance. A few days later she developed monocular blindness. What will be the most likely diagnosis?
A. acute disseminated encephalomyelitis
B. devic disease
C. primary progressive MS
D. transverse myelitis
B. devic disease
This type of multiple sclerosis is characterized by a disease that gradually gets worse over time. There are no well-defined attacks of symptoms and there is little or no remissions?
A. relapsing remitting MS
B. primary progressive MS
C. progressive relapsing MS
D. secondary progressive MS
B. primary progressive MS
The following are signs and symptoms of peripheral neuropathy, except:
A. brisk tendon reflexes
B. stocking and glove cutaneous sensory loss
C. impaired position and vibration sense
D. distal muscle weakness
A. brisk tendon reflexes
Match the neuropathic condition with its appropriate presentation and/or clinical manifestation
- Distal, symmetrical, primarily sensory form of polyneuropathy associated with chronically elevated glycosylated hemoglobin
- Chronic sensory polyneuropathy associated with very high creatinine levels
- Characteristically presents with wrist and finger drop after chronic exposure to fumes from smelting industries, burning batteries of old paint formulas
- presents with dysphagia and nasal voice
A. Lead neuropathy
B. Diabetic neuropathy
C. Uremic neuropathy
D. Diphtheritic neuropathy
- B
- C
- A
- D
Match the nerve with its anatomical location for entrapment/compression
- Carpal tunnel
- Cubital tunnel
- Tarsal tunnel
- Fibular head
A. Peroneal nerve
B. Tibial nerve
C. Median nerve
D. Ulnar nerve
- C
- D
- B
- A
Match the clinical phase of GBS with it’s most distinguishing presentation
- Mechanical ventilation
- Difficulty arising from chair
- Areflexia
- Rehabilitation
A. Phase 2
B. Phase 5
C. Phase 6
D. Phase 3
- B
- A
- D
- C
Which among the following is LEAST likely to be reported as the antecedent event in Guillain-Barre syndrome?
A. Head trauma
B. Vaccination
C. Surgery
D. Gastrointestinal infection
A. Head trauma
Match the Stage or Class of Myasthenia Gravis with it’s appropriate presentation based on Osserman’s Classification
- Ocular myasthenia
- Late severe myasthenia, fulminating, with respiratory crises, with progression of symptoms occuring over 2 years from class 1 to 2
- Acute fulminating, rapid progression with respiratory crises, poor response to treatment
- Mild generalized, Slow progression, no crises, drug responsive
A. Class 1
B. Class 2
C. Class 3
D. Class 4
- A
- D
- C
- B
A 35 year old female came for consult due to sudden onset of left sided body numbness and weakness.
1 year prior the present symptom she developed blurring of vision on the left eye accompanied by pain around the eye. At the age of 25, during her pregnancy, she developed sudden onset of bilateral lower extremity weakness accompanied by loss of control while urinating that lasted for 1 month but spontaneously resolved.
What will be your primary consideration in this case?
Multiple sclerosis
A 35 year old female came for consult due to sudden onset of left sided body numbness and weakness.
1 year prior the present symptom she developed blurring of vision on the left eye accompanied by pain around the eye. At the age of 25, during her pregnancy, she developed sudden onset of bilateral lower extremity weakness accompanied by loss of control while urinating that lasted for 1 month but spontaneously resolved. If she had presented with paralysis of adduction and nystagmus of the abducting eye, where will you place your lesion?
Medial longitudinal fasciculus
A 35 year old female came for consult due to sudden onset of left sided body numbness and weakness.
1 year prior the present symptom she developed blurring of vision on the left eye accompanied by pain around the eye. At the age of 25, during her pregnancy, she developed sudden onset of bilateral lower extremity weakness accompanied by loss of control while urinating that lasted for 1 month but spontaneously resolved. If she had presented with paralysis of adduction and nystagmus of the abducting eye, where will you place your lesion?
Medial longitudinal fasciculus
A 35 year old female came for consult due to sudden onset of left sided body numbness and weakness.
1 year prior the present symptom she developed blurring of vision on the left eye accompanied by pain around the eye. At the age of 25, during her pregnancy, she developed sudden onset of bilateral lower extremity weakness accompanied by loss of control while urinating that lasted for 1 month but spontaneously resolved.
What did this patient have a year before the current symptoms?
Optic neuritis
A 35 year old female came for consult due to sudden onset of left sided body numbness and weakness.
1 year prior the present symptom she developed blurring of vision on the left eye accompanied by pain around the eye. At the age of 25, during her pregnancy, she developed sudden onset of bilateral lower extremity weakness accompanied by loss of control while urinating that lasted for 1 month but spontaneously resolved.
What will be the best diagnostic tool to use in this case?
Magnetic resonance imaging
The following conditions are associated with bilateral carpal tunnel syndrome except?
A. Diabetes
B. Repetitive wrist motion
C. Pregnancy
D. Hypothyroidism
A. Diabetes
Most common syndrome of diabetic neuropathy is
Distal, symmetrical, sensory polyneuropathy
Which cranial nerve is most commonly affected by sarcoid neuropathy
Seventh cranial nerve (Facial nerve)
The most common cause of polyneuropathy in clinical practice is
Diabetic neuropathy
Which among the following is a stimulus evoked neuropathic pain?
A. Allodynia
B. Causalgia
C. Paresthesia
D. Dysesthesia
A. Allodynia
The most common manifestation of Lead Neuropathy is:
A. Wrist and finger drop
B. Glove and stocking distribution of numbness
C. Weakness of lower extremities
D. Ophthalmoparesis
A. Wrist and finger drop
Which among the following characteristically presents as an acute demyelinating polyneuropathy with dysphagia and nasal voice?
A. Alcoholic neuropathy
B. Uremic neuropathy
C. Diphtheritic neuropathy
D. Neuropathy due to arsenic poisoning
C. Diphtheritic neuropathy
The most common cause of severe and chronic low back pain is
Intervertebral disc herniation
An EMG-NCV test does the following, EXCEPT:
A. Localize the site of the injury along the course of the motor unit
B. Suggest nerve pathology (either axonal or demyelinating)
C. Determine if the condition is neuropathic or myopathic
D. Provides the final pathologic diagnosis
D. Provides the final pathologic diagnosis
Chronic idiopathic demyelinating polyneuropathy (CIDP) is differentiated from GBS by which of the following?
A. Responsiveness to corticosteroids
B. Enlargement of the nerves
C. Prolonged and relapsing course
D. All of the above
D. All of the above
